Cardiovascular Center Aalst OLV Hospital, Aalst, Belgium.
J Thromb Haemost. 2012 Dec;10(12):2452-61. doi: 10.1111/jth.12016.
Percutaneous coronary intervention (PCI) modulates platelet reactivity (PR).
To assess: (i) the impact of coronary interventions on periprocedural variations (Δ) of PR; (ii) whether ΔPR correlates with periprocedural myocardial infarction (PMI); and (iii) the mechanisms of these variations in vitro.
We enrolled 65 patients on aspirin (80-100 mg day(-1)) and clopidogrel (600 mg, 12 h before PCI): 15 with coronary angiography (CA group), 40 with PCI (PCI group), and 10 with rotational atherectomy plus PCI (RA group). PR was assessed by ADP, high-sensitivity ADP and thrombin receptor activator peptide 6 tests prior to, immediately after and 24 h after the procedure. E-selectin and ICAM-1 were assessed prior to and immediately after the procedure. In vitro, PR was measured during pulsatile blood flow at baseline, after balloon inflation and after stent implantation in six porcine carotid arteries and five plastic tubes. PR declined in the CA group, but significantly increased in the PCI and RA groups immediately postprocedure, and decreased to baseline at 24 h. ΔPR increased across the three groups (P < 0.0001). In the PCI group, ΔPR was directly related to total inflation time (r = 0.435, P = 0.005) and total stent length (r = 0.586, P < 0.001). The change in E-selectin significantly and inversely correlated with ΔPR (P < 0.001). No correlation was found with sICAM-1. PR increased significantly more in patients with PMI than in patients without PMI (P = 0.013). In vitro, platelet activation was observed in the presence of carotid arteries but not in the presence of plastic tubes.
Despite dual antiplatelet therapy, PCI affected platelet function proportionally to procedural complexity and the extent of vascular damage.
经皮冠状动脉介入治疗（PCI）可调节血小板反应性（PR）。
评估：（i）冠状动脉介入对围手术期 PR 变化（Δ）的影响；（ii）ΔPR 是否与围手术期心肌梗死（PMI）相关；以及（iii）这些变化的体外机制。
我们招募了 65 例服用阿司匹林（80-100 mg/天）和氯吡格雷（PCI 前 12 小时 600 mg）的患者：15 例接受冠状动脉造影（CA 组），40 例接受 PCI（PCI 组），10 例接受旋磨加 PCI（RA 组）。在介入治疗前、即刻和 24 小时后，通过 ADP、高敏 ADP 和血栓素受体激活肽 6 试验评估 PR。在介入治疗前和即刻评估 E-选择素和 ICAM-1。在体外，在六只猪颈动脉和五根塑料管中，在基础状态、球囊扩张后和支架植入后，测量 PR 在脉动血流中的变化。在 CA 组中，PR 下降，但在 PCI 和 RA 组中即刻显著增加，并在 24 小时时降至基线。ΔPR 在三组中均增加（P < 0.0001）。在 PCI 组中，ΔPR 与总充气时间（r = 0.435，P = 0.005）和总支架长度（r = 0.586，P < 0.001）直接相关。E-选择素的变化与ΔPR 呈显著负相关（P < 0.001）。与 sICAM-1 无相关性。与无 PMI 患者相比，有 PMI 患者的 PR 增加更显著（P = 0.013）。在体外，在存在颈动脉的情况下观察到血小板活化，但在存在塑料管的情况下未观察到血小板活化。
尽管进行了双联抗血小板治疗，PCI 仍会根据手术复杂性和血管损伤程度，对血小板功能产生相应影响。
