Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Cardiovascular Research Institute, Busan Paik Hospital, Busan, South Korea.
Int J Cardiol. 2013 Sep 1;167(5):1877-81. doi: 10.1016/j.ijcard.2012.04.154. Epub 2012 Jun 9.
Recent studies have shown that post-clopidogrel high platelet reactivity (HPR), assessed by a point-of-care assay, is associated with a higher risk of adverse events after percutaneous coronary intervention (PCI). We assessed the clinical impact of HPR by the VerifyNow P2Y12 point-of-care assay in 181 patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary PCI with drug-eluting stents (DES) at 3 hospitals.
The primary endpoint of the study was the 12-month major adverse cardiovascular events (MACE), which comprised cardiovascular death, nonfatal MI and ischemic stroke. All patients received a single loading dose of 600 mg clopidogrel and 300 mg aspirin followed by a daily maintenance dose of 75 mg clopidogrel and 100mg aspirin.
A P2Y12 reaction unit (PRU) ≥ 282 (AUC 0.719, 95% CI 0.588-0.851, p=0.004, sensitivity 68.8%, specificity 73.8%) was the optimal cut-off value in predicting 12-month MACE by receiver operating characteristic curve analysis. Occurrence of MACE was significantly more frequent in patients with HPR (PRU ≥ 282) compared to patients without HPR (20.4% vs. 3.9%, HR 6.24, 95% CI 2.05-18.99, p=0.001). By multivariate analysis, HPR (HR 3.84, 95% CI 1.17-12.58, p=0.026) and elderly patients above 80 years of age (HR: 8.13, 95% CI 1.79-37.03, p=0.007) were found to be the significant predictors of 12-month MACE. The MACE-free survival rate was significantly lower in patients with HPR compared to patients without HPR (p<0.001).
HPR assessed by a point-of-care assay was able to predict 12-month MACE in patients with STEMI who underwent primary PCI with DES.
最近的研究表明，通过即时检测（point-of-care assay）评估的氯吡格雷抵抗后高血小板反应性（HPR）与经皮冠状动脉介入治疗（PCI）后不良事件的风险增加相关。我们在 3 家医院中评估了 181 例 ST 段抬高型心肌梗死（STEMI）患者接受药物洗脱支架（DES）的直接 PCI 后，通过 VerifyNow P2Y12 即时检测评估 HPR 的临床影响。
研究的主要终点是 12 个月的主要不良心血管事件（MACE），包括心血管死亡、非致死性心肌梗死和缺血性卒中。所有患者接受单次负荷剂量 600mg 氯吡格雷和 300mg 阿司匹林，随后每天维持剂量 75mg 氯吡格雷和 100mg 阿司匹林。
通过接受者操作特征曲线分析，P2Y12 反应单位（PRU）≥282（AUC 0.719，95%CI 0.588-0.851，p=0.004，敏感性 68.8%，特异性 73.8%）是预测 12 个月 MACE 的最佳截断值。与无 HPR（PRU<282）的患者相比，HPR（PRU≥282）患者的 MACE 发生率明显更高（20.4%比 3.9%，HR 6.24，95%CI 2.05-18.99，p=0.001）。多变量分析显示，HPR（HR 3.84，95%CI 1.17-12.58，p=0.026）和 80 岁以上的老年患者（HR：8.13，95%CI 1.79-37.03，p=0.007）是 12 个月 MACE 的显著预测因素。与无 HPR 的患者相比，HPR 患者的 MACE 无事件生存率明显较低（p<0.001）。
通过即时检测评估的 HPR 可预测接受 DES 直接 PCI 的 STEMI 患者 12 个月的 MACE。
