氯吡格雷治疗后血小板高反应性：稳定型心绞痛患者经皮冠状动脉介入治疗后冠状动脉粥样硬化程度和围手术期心肌梗死。
High residual platelet reactivity after clopidogrel: extent of coronary atherosclerosis and periprocedural myocardial infarction in patients with stable angina undergoing percutaneous coronary intervention.
机构信息
Cardiovascular Center, OLV Hospital, Aalst, Belgium.
出版信息
JACC Cardiovasc Interv. 2010 Jan;3(1):35-40. doi: 10.1016/j.jcin.2009.10.024.
OBJECTIVES
We tested the hypothesis that residual platelet reactivity after clopidogrel correlates with the extent and severity of coronary atherosclerosis in patients undergoing elective percutaneous coronary intervention (PCI).
BACKGROUND
Platelets are actively involved in vascular atherosclerosis.
METHODS
We prospectively enrolled 338 patients undergoing PCI for stable angina, loaded with 600-mg clopidogrel. Platelet reactivity was assessed 12 h later by measuring P2Y12 reactivity unit (PRU) with VerifyNow P2Y12 assay (Accumetrics, San Diego, California). High platelet reactivity (HPR) was defined as PRU value >or=240. Presence of multivessel disease (MVD) and total stent length (TSL) were used as surrogate markers of atherosclerosis severity and extension.
RESULTS
Patients with MVD showed higher PRU compared with single-vessel disease (SVD) patients (222 +/- 85 vs. 191 +/- 73; p < 0.001). The PRU increased with the number of stenotic coronaries (1-vessel disease: 191 +/- 73; 2-vessel disease: 220 +/- 88; 3-vessel disease: 226 +/- 80; p = 0.002). The PRU was higher in the third TSL tertile compared with first tertile (217 +/- 83 vs. 191 +/- 73; p = 0.048). The HPR was most frequently observed among MVD patients (40.5% vs. 21.6% in patients with SVD, respectively; p < 0.001) and those in the third TSL tertile (35.8% vs. 22.2% first tertile; p = 0.028). Higher incidence of periprocedural myocardial infarction was observed in patients with HPR (41.2% vs. 26.7% in patients without HPR; p = 0.008) and in those in the third tertile TSL (37.7% vs. 23.1% first tertile; p = 0.020). By multivariate analysis, HPR was the only independent predictor of periprocedural myocardial infarction (p = 0.034).
CONCLUSIONS
Patients with more extensive coronary atherosclerosis have a higher rate of HPR, which might partly account for higher risk of periprocedural MI.
目的
我们检验了以下假说，即在接受择期经皮冠状动脉介入治疗（PCI）的患者中，氯吡格雷治疗后的残余血小板反应性与冠状动脉粥样硬化的程度和严重程度相关。
背景
血小板在血管粥样硬化中起积极作用。
方法
我们前瞻性地纳入了 338 例因稳定型心绞痛而行 PCI 的患者，这些患者术前给予氯吡格雷负荷量 600mg。12 小时后通过 Accumetrics 公司的 VerifyNow P2Y12 检测血小板反应单位（PRU）评估血小板反应性。高血小板反应性（HPR）定义为 PRU 值>240。多血管病变（MVD）和总支架长度（TSL）作为动脉粥样硬化严重程度和范围的替代标志物。
结果
与单血管病变（SVD）患者相比，MVD 患者的 PRU 值更高（222±85 比 191±73；p<0.001）。随着狭窄冠状动脉数量的增加，PRU 值也升高（1 支病变：191±73；2 支病变：220±88；3 支病变：226±80；p=0.002）。与 TSL 第 1 三分位相比，第 3 三分位的 PRU 值更高（217±83 比 191±73；p=0.048）。HPR 最常发生在 MVD 患者中（分别为 40.5%和 SVD 患者中的 21.6%；p<0.001）和 TSL 第 3 三分位患者中（分别为 35.8%和第 1 三分位的 22.2%；p=0.028）。HPR 患者（41.2%比无 HPR 患者的 26.7%；p=0.008）和 TSL 第 3 三分位患者（37.7%比第 1 三分位的 23.1%；p=0.020）围手术期心肌梗死发生率更高。多变量分析显示，HPR 是围手术期心肌梗死的唯一独立预测因子（p=0.034）。
结论
冠状动脉粥样硬化程度更严重的患者 HPR 发生率更高，这可能部分解释了围手术期 MI 风险较高的原因。
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