Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Lazarettstrasse 36, 80636 München, Germany.
Thromb Haemost. 2010 Jan;103(1):151-9. doi: 10.1160/TH09-05-0284. Epub 2009 Oct 26.
Clopidogrel low-responsiveness assessed with multiple electrode platelet aggregometry (MEA) has been shown to be a strong and independent predictor of early stent thrombosis (ST) after coronary stenting. The relation of clopidogrel response status, as assessed with MEA, with incidence and timing of ST during an extended follow-up period has never been reported. Here, we report the six-month follow-up results of a prospective trial assessing clopidogrel responsiveness with MEA in patients undergoing percutaneous coronary intervention (PCI). A total of 1,608 consecutive patients with planned drug-eluting stent placement were enrolled in this study. Before PCI patients uniformly received 600 mg clopidogrel and blood was taken directly before PCI to measure ADP-induced platelet aggregation with MEA. The upper quintile (20%) of patients according to MEA measurements (n=323) was defined as clopidogrel low responders. Compared with normal responders (n=1,285), the cumulative incidence of definite ST within six months was significantly higher in low responders [2.5% vs. 0.4%; OR 6.5; 95% CI, 2.4-17.0; P<0.001]. The combined incidence of definite or probable ST was higher as well in low vs. normal responders [4.1% vs. 0.7%; OR 5.8; 95% CI, 2.8-12.3; P<0.0001]. A significant inverse correlation of MEA values and the timing of definite or probable ST (in days) was observed (Spearman coefficient = -0.45; P=0.04) with events occurring earlier in the low-responder group. MEA measurements are highly predictive for the occurrence of ST during the first six months following coronary stenting. In the majority of clopidogrel low responders suffering ST, the ischaemic event occurs early in the course after the procedure.
采用多电极血小板聚集仪(MEA)评估的氯吡格雷低反应性已被证实是冠状动脉支架置入术后早期支架血栓形成(ST)的强而独立的预测因子。但是,采用 MEA 评估的氯吡格雷反应状态与延长随访期间 ST 的发生率和时间的关系尚未见报道。在此,我们报告了一项前瞻性试验的 6 个月随访结果,该试验采用 MEA 评估经皮冠状动脉介入治疗(PCI)患者的氯吡格雷反应性。这项研究共纳入了 1608 例计划置入药物洗脱支架的连续患者。在 PCI 前,所有患者均统一接受 600mg 氯吡格雷治疗,并在 PCI 前直接采血,采用 MEA 测量 ADP 诱导的血小板聚集。根据 MEA 测量结果,将患者分为上五分位(20%)(n=323)定义为氯吡格雷低反应者。与正常反应者(n=1285)相比,低反应者在 6 个月内明确 ST 的累积发生率显著较高[2.5%比 0.4%;OR 6.5;95%CI,2.4-17.0;P<0.001]。低反应者与正常反应者相比,明确或可能 ST 的联合发生率也较高[4.1%比 0.7%;OR 5.8;95%CI,2.8-12.3;P<0.0001]。观察到 MEA 值与明确或可能 ST(以天数计)的时间之间存在显著的负相关关系(Spearman 系数=-0.45;P=0.04),低反应者组的事件发生时间更早。MEA 测量值对冠状动脉支架置入后 6 个月内 ST 的发生具有高度预测性。在大多数氯吡格雷低反应者发生 ST 的情况下,缺血事件发生在手术后的早期。