阿司匹林和氯吡格雷反应对经皮冠状动脉介入术后心肌坏死的影响：BRIEF-PCI（经皮冠状动脉介入成功后静脉注射依替巴肽短期输注）试验子研究

The effects of aspirin and clopidogrel response on myonecrosis after percutaneous coronary intervention: a BRIEF-PCI (Brief Infusion of Intravenous Eptifibatide Following Successful Percutaneous Coronary Intervention) trial substudy.

作者信息

Saw Jacqueline, Densem Cameron, Walsh Simon, Jokhi Percy, Starovoytov Andrew, Fox Rebecca, Wong Graham, Buller Christopher, Ricci Donald, Mancini G B John, Fung Anthony

机构信息

Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

JACC Cardiovasc Interv. 2008 Dec;1(6):654-9. doi: 10.1016/j.jcin.2008.08.017.

DOI:10.1016/j.jcin.2008.08.017

PMID:19463380

Abstract

OBJECTIVES

The purpose of this study was to evaluate the effects of aspirin and clopidogrel response on myonecrosis after percutaneous coronary intervention (PCI) with glycoprotein (GP) IIb/IIIa blockade.

BACKGROUND

Aspirin and clopidogrel resistance is increasingly recognized, but its effects on PCI outcomes with GP IIb/IIIa blockade are unknown.

METHODS

This was a prospective, pre-specified substudy of the BRIEF-PCI (Brief Infusion of Intravenous Eptifibatide Following Successful Percutaneous Coronary Intervention) trial, which randomized 624 patients to 18-h or <2-h eptifibatide infusion after uncomplicated PCI. To be eligible, patients must have been pre-treated with aspirin (>or=5 days) and clopidogrel (75 mg/day >or=5 days, 300 mg loading >or=6 h, or 600 mg loading >or=2 h) and must not have received GP IIb/IIIa inhibitors within 48 h. Verify-Now Aspirin and Clopidogrel (P2Y(12)) assays were performed at baseline before PCI. Patients with aspirin reaction unit (ARU) >or=550 were labeled as aspirin resistant. Clopidogrel low-responders were defined as those in the lowest quartile of platelet inhibition. The primary end point was the prevalence of myonecrosis within 24 h after PCI.

RESULTS

We enrolled 209 patients into our substudy, of which 185 had aspirin response assessed, 198 had clopidogrel response assessed, and 174 had both assessed. There were 4.9% who were aspirin resistant. Clopidogrel low-responders were defined as those in the lowest quartile with platelet inhibition <19%. Only 1.1% had both aspirin resistance and low clopidogrel response. There was no difference in myonecrosis prevalence among aspirin-resistant compared with aspirin-sensitive patients (11.1% vs. 27.8%, p = 0.259) or among clopidogrel low-responders compared with clopidogrel responders (23.5% vs. 29.3%, p = 0.433).

CONCLUSIONS

Aspirin and clopidogrel response did not affect myonecrosis prevalence amongst patients who received eptifibatide for PCI.

摘要

目的

本研究旨在评估阿司匹林和氯吡格雷反应对经皮冠状动脉介入治疗（PCI）联合糖蛋白（GP）IIb/IIIa受体阻滞剂时心肌坏死的影响。

背景

阿司匹林和氯吡格雷抵抗日益受到关注，但其对PCI联合GP IIb/IIIa受体阻滞剂治疗结果的影响尚不清楚。

方法

这是BRIEF-PCI（经皮冠状动脉介入治疗成功后静脉注射依替巴肽短期输注）试验的一项前瞻性、预先指定的子研究，该试验将624例患者随机分为PCI成功后接受18小时或<2小时依替巴肽输注两组。符合条件的患者必须已预先接受阿司匹林治疗（≥5天）和氯吡格雷治疗（75毫克/天≥5天，负荷剂量300毫克≥6小时，或负荷剂量600毫克≥2小时），且在48小时内未接受GP IIb/IIIa抑制剂治疗。在PCI前基线时进行Verify-Now阿司匹林和氯吡格雷（P2Y(12)）检测。阿司匹林反应单位（ARU）≥550的患者被标记为阿司匹林抵抗。氯吡格雷低反应者定义为血小板抑制处于最低四分位数的患者。主要终点是PCI后24小时内心肌坏死的发生率。

结果

我们将209例患者纳入子研究，其中185例评估了阿司匹林反应，198例评估了氯吡格雷反应，174例两者均进行了评估。阿司匹林抵抗者占4.9%。氯吡格雷低反应者定义为血小板抑制<19%的最低四分位数患者。只有1.1%的患者同时存在阿司匹林抵抗和氯吡格雷低反应。阿司匹林抵抗患者与阿司匹林敏感患者的心肌坏死发生率无差异（11.1%对27.8%，p = 0.259），氯吡格雷低反应者与氯吡格雷反应者的心肌坏死发生率也无差异（23.5%对29.3%，p = 0.433）。