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在非ST段抬高型急性冠脉综合征患者中，治疗后血小板反应性比氯吡格雷反应更能预测长期不良事件。

Post-treatment platelet reactivity predicts long-term adverse events better than the response to clopidogrel in patients with non-ST-segment elevation acute coronary syndrome.

作者信息

de Miguel Castro Antonio, Cuellas Ramón Carlos, Diego Nieto Alejandro, Samaniego Lampón Beatriz, Alonso Rodríguez David, Fernández Vázquez Felipe, Alonso Orcajo Norberto, Carbonell de Blas Raúl, Pascual Vicente Cristina, Pérez de Prado Armando

机构信息

Servicio de Cardiología, Hospital de León, León, Spain.

出版信息

Rev Esp Cardiol. 2009 Feb;62(2):126-35. doi: 10.1016/s1885-5857(09)71530-0.

DOI:10.1016/s1885-5857(09)71530-0

PMID:19232185

Abstract

INTRODUCTION AND OBJECTIVES

Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The objective of this study is to assess the relationship between response to clopidogrel and post-treatment platelet reactivity (PPR) and 1-year major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS).

METHODS

Patients with NSTEACS undergoing early coronary angiography were enrolled in this prospective, observational study. The VerifyNow analyzer was used to measure clopidogrel response and PPR immediately before coronary angiography.

RESULTS

Of the 179 patients included (97 percutaneous coronary intervention, 21 coronary artery bypass graft), 161 (90%) completed 1-year follow-up and 18 (11%) incurred MACE: 10 deaths, 6 myocardial infarctions, 2 strokes, 5 revascularizations. Lower response to clopidogrel (31 +/- 21% vs. 43 +/- 21%; P.049) and higher PPR (204 +/- 60 vs. 155 +/- 67 platelet reaction units [PRU]; p= 0.006) were significantly associated with MACE occurrence. Multivariate analysis confirmed PPR (OR per 10-unit increase: 1.12, 95%CI: 1.01-1.24; P.020) as an independent predictor of MACE. A PPR cut-off value of 175 PRU was associated with an adjusted OR for 1-year MACE occurrence of 3.9 (95%CI: 1.2-15.4; P.024).

CONCLUSIONS

PPR predicts adverse long-term outcomes better than response to clopidogrel in patients with NSTEACS. Patients with PPR values above 175 PRU were identified as being at higher risk for adverse long-term events.

摘要

引言与目的

抗血小板治疗反应不佳与不良的长期预后相关。本研究的目的是评估非ST段抬高型急性冠状动脉综合征（NSTEACS）患者对氯吡格雷的反应与治疗后血小板反应性（PPR）及1年主要不良心血管事件（MACE）之间的关系。

方法

本前瞻性观察性研究纳入了接受早期冠状动脉造影的NSTEACS患者。在冠状动脉造影前即刻使用VerifyNow分析仪测量氯吡格雷反应和PPR。

结果

纳入的179例患者（97例行经皮冠状动脉介入治疗，21例行冠状动脉旁路移植术）中，161例（90%）完成了1年随访，18例（11%）发生了MACE：10例死亡，6例心肌梗死，2例中风，5例血运重建。氯吡格雷反应较低（31±21%对43±21%；P = 0.049）和PPR较高（204±60对155±67血小板反应单位[PRU]；p = 0.006）与MACE发生显著相关。多变量分析证实PPR（每增加10个单位的OR：1.12，95%CI：1.01 - 1.24；P = 0.020）是MACE的独立预测因素。PPR临界值为175 PRU与1年MACE发生的校正OR为3.9（95%CI：1.2 - 15.4；P = 0.024）相关。