Department of Laboratory Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Drugs R D. 2010;10(4):219-24. doi: 10.2165/11539580-000000000-00000.
There are limited prospective data on clopidogrel resistance and clinical outcome of patients with selective coronary drug-eluting stent (DES) implantation.
To investigate whether clopidogrel resistance is associated with long-term thrombotic events in patients with selective coronary DES implantation.
A total of 154 patients who underwent selective percutaneous coronary intervention (PCI) with DES were enrolled in this study. Platelet aggregation was measured using light transmittance aggregometry (LTA) before clopidogrel administration (baseline) and 24 hours after loading with clopidogrel 300 mg. Clopidogrel resistance was defined as ≤10% absolute difference between baseline aggregation and post-administration aggregation. All patients who received the same anti-platelet treatment were followed up for 1 year after discharge for the incidence of a composite endpoint consisting of cardiovascular death, myocardial infarction (MI) and revascularization, and secondly for the incidence of stent thrombosis.
The incidence of clopidogrel resistance is 20.28% in our study population. Patients who are complicated by diabetes mellitus, smoke, or have a higher body mass index (BMI) tend to have clopidogrel resistance. Patients in the clopidogrel-resistant group have significantly higher incidences of composite endpoints (21.88% vs 4.92%; p = 0.006) and stent thrombosis (12.5% vs 1.64%; p = 0.017) than patients in the clopidogrel-response group during 1-year follow-up.
Diabetes, smoking, and high BMI are associated with clopidogrel resistance, and clopidogrel resistance indicates an increased risk of long-term thrombotic events in patients implanted with DES.
选择性冠状动脉药物洗脱支架（DES）植入患者的氯吡格雷抵抗和临床结局的前瞻性数据有限。
研究氯吡格雷抵抗是否与选择性冠状动脉 DES 植入患者的长期血栓事件相关。
本研究共纳入 154 例接受选择性经皮冠状动脉介入治疗（PCI）和 DES 的患者。在氯吡格雷给药前（基线）和氯吡格雷 300mg 负荷后 24 小时，使用光透射聚集仪（LTA）测量血小板聚集。氯吡格雷抵抗定义为基线聚集与给药后聚集之间的绝对差异≤10%。所有接受相同抗血小板治疗的患者在出院后 1 年内随访复合终点（包括心血管死亡、心肌梗死（MI）和血运重建）的发生率，其次是支架血栓形成的发生率。
本研究人群中氯吡格雷抵抗的发生率为 20.28%。合并糖尿病、吸烟或体重指数（BMI）较高的患者更易发生氯吡格雷抵抗。氯吡格雷抵抗组的复合终点（21.88%比 4.92%；p=0.006）和支架血栓形成（12.5%比 1.64%；p=0.017）发生率明显高于氯吡格雷反应组，在 1 年随访期间。
糖尿病、吸烟和高 BMI 与氯吡格雷抵抗相关，氯吡格雷抵抗表明 DES 植入患者发生长期血栓事件的风险增加。
