经皮冠状动脉介入治疗的未选择患者中氯吡格雷对 P2Y12 抑制对心血管死亡率的影响：一项前瞻性登记研究。

Impact of P2Y12 inhibition by clopidogrel on cardiovascular mortality in unselected patients treated by percutaneous coronary angioplasty: a prospective registry.

机构信息

Pôle d'activité médico-chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France.

出版信息

JACC Cardiovasc Interv. 2010 Jun;3(6):648-56. doi: 10.1016/j.jcin.2010.03.003.

DOI:10.1016/j.jcin.2010.03.003

PMID:20630458

Abstract

OBJECTIVES

The aim of this study was to determine whether low platelet response to the P2Y(12) receptor antagonist clopidogrel as assessed by Vasodilator-stimulated phosphoprotein flow cytometry test (VASP- FCT) predicts cardiovascular events in a high-risk population undergoing percutaneous coronary intervention (PCI).

BACKGROUND

Impaired platelet responsiveness to clopidogrel is thought to be a determinant of cardiovascular events after PCI. The platelet VASP-FCT is a new assay specific to the P2Y(12) adenosine diphosphate receptor-pathway. In this test, platelet activation is expressed as platelet reactivity index (PRI).

METHODS

Four-hundred sixty-one unselected patients undergoing urgent (n = 346) or planned (n = 115) PCI were prospectively enrolled. Patients were classified as low-response (LR) and response (R) to clopidogrel, depending on their PRI. Optimal PRI cutoff was determined by receiver-operator characteristic curve analysis to 61% (LR: PRI > or =61% and R: PRI <61%). Follow-up was obtained at a mean of 9 +/- 2 months in 453 patients (98.3%).

RESULTS

At follow-up, total cardiac mortality rates and possible and total stent thrombosis were higher in LR patients. Multivariate analysis identified creatinine clearance (hazard ratio [HR]: 0.95; 95% confidence interval [CI]: 0.93 to 0.98, p < 0.001), drug-eluting stent (HR: 5.73; 95% CI: 1.40 to 23.43, p = 0.015), C-reactive protein (HR: 1.01; 95% CI: 1.001 to 1.019, p = 0.024), and LR to clopidogrel (HR: 4.00; 95% CI: 1.08 to 14.80, p = 0.037) as independent predictors of cardiac death. The deleterious impact of LR to clopidogrel on cardiovascular death was significantly higher in patients implanted with drug-eluting stent.

CONCLUSIONS

In patients undergoing PCI, LR to clopidogrel assessed by VASP-FCT is an independent predictor of cardiovascular death at the PRI cutoff value of > or =61%. The LR clinical impact seems to be dependent on the type of stent implanted.

摘要

目的

本研究旨在通过血小板激活蛋白流式细胞术(VASP-FCT)评估氯吡格雷低血小板反应，以确定其在接受经皮冠状动脉介入治疗(PCI)的高危人群中是否可预测心血管事件。

背景

氯吡格雷血小板反应受损被认为是 PCI 后心血管事件的决定因素。血小板 VASP-FCT 是一种针对 P2Y(12)二磷酸腺苷受体途径的新检测方法。在该检测中，血小板激活以血小板反应指数(PRI)表示。

方法

前瞻性纳入 461 例接受紧急(346 例)或计划(115 例)PCI 的未选择患者。根据 PRI 将患者分为氯吡格雷低反应(LR)和反应(R)。通过接收者操作特征曲线分析确定最佳 PRI 截断值为 61%(LR:PRI≥61%，R:PRI<61%)。453 例患者平均随访 9±2 个月(98.3%)。

结果

随访时，LR 患者的全因死亡率、可能的和总支架血栓形成率更高。多变量分析确定了肌酐清除率(危险比[HR]:0.95；95%置信区间[CI]:0.93 至 0.98，p<0.001)、药物洗脱支架(HR:5.73；95%CI:1.40 至 23.43，p=0.015)、C 反应蛋白(HR:1.01；95%CI:1.001 至 1.019，p=0.024)和氯吡格雷低反应(HR:4.00；95%CI:1.08 至 14.80，p=0.037)为全因死亡的独立预测因子。在植入药物洗脱支架的患者中，氯吡格雷低反应对心血管死亡的不良影响显著更高。