Department of Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del Portillo 200, Rome, Italy.
JACC Cardiovasc Interv. 2010 Mar;3(3):318-23. doi: 10.1016/j.jcin.2009.12.012.
We sought to evaluate the influence of platelet reactivity after clopidogrel, as assessed by the VerifyNow point-of-care assay (Accumetrics, San Diego, California), on myonecrosis in low-to-intermediate risk patients undergoing percutaneous coronary intervention (PCI).
Inadequate platelet inhibition at the time of PCI is associated with a higher risk of recurrent ischemic events.
A total of 250 consecutive biomarker-negative patients treated with clopidogrel and undergoing elective PCI were enrolled. Cardiac biomarkers (creatine kinase-myocardial band and troponin I) were measured before and 8 and 24 h after intervention. Platelet reactivity after clopidogrel was assessed immediately before PCI by the VerifyNow P2Y12 point-of-care assay. High platelet reactivity (HPR) after clopidogrel was defined as a platelet reaction unit value > or =240.
Patients with HPR (31% of the overall population) showed more frequent myonecrosis, with statistical significance with regard to creatine kinase-myocardial band elevation (35% vs. 20%; p = 0.011), and by trend with regard to troponin-I elevation (47% vs. 35%; p = 0.059). Incidence of periprocedural myocardial infarction was higher in patients with HPR, both by creatine kinase-myocardial band (13% vs. 4%; p = 0.011) and troponin-I definition (32% vs. 19%; p = 0.019). By multivariable analysis, HPR was an independent predictor of periprocedural myocardial infarction.
Easily assessed by a point-of-care assay, HPR after clopidogrel is a frequent finding and is associated with increased risk of myonecrosis in low-to-intermediate risk patients undergoing planned PCI.
我们旨在评估经皮冠状动脉介入治疗（PCI）患者中，使用即时检验（point-of-care assay，POCA）检测的氯吡格雷抵抗（platelet reactivity after clopidogrel，PRAC）对低-中危患者发生心肌坏死(myonecrosis)的影响。
PCI 时血小板抑制不足与复发性缺血事件风险增加相关。
共纳入 250 例连续接受氯吡格雷治疗且行择期 PCI 的生物标志物阴性患者。在介入治疗前、后 8 小时和 24 小时测量心肌酶谱（肌酸激酶同工酶和肌钙蛋白 I）。在 PCI 前即刻使用 VerifyNow P2Y12 POCA 检测氯吡格雷后血小板反应性。氯吡格雷后高血小板反应性（high platelet reactivity，HPR）定义为血小板反应单位值≥240。
HPR 患者（占总人群的 31%）发生心肌坏死的频率更高，且与肌酸激酶同工酶升高具有统计学意义（35% vs. 20%，p=0.011），与肌钙蛋白 I 升高呈趋势性相关（47% vs. 35%，p=0.059）。HPR 患者的围术期心肌梗死发生率更高，通过肌酸激酶同工酶（13% vs. 4%，p=0.011）和肌钙蛋白 I 定义（32% vs. 19%，p=0.019）两种方法均得到证实。多变量分析表明，HPR 是围术期心肌梗死的独立预测因子。
HPR 可通过 POCA 轻松评估，在低-中危接受计划 PCI 的患者中较为常见，且与心肌坏死风险增加相关。
