Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Am J Cardiol. 2013 Jun 15;111(12):1739-44. doi: 10.1016/j.amjcard.2013.02.028. Epub 2013 Mar 26.
The incremental predictive value of high inflammatory status and high on-treatment platelet reactivity (HPR) on the occurrence of periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) has not been characterized. The aim of this study was to evaluate the correlation of elevated C-reactive protein (CRP) level and/or HPR with the incidence of PMI in patients who undergo PCI. Five hundred consecutive patients treated with clopidogrel who underwent PCI had preprocedural measurement of CRP levels and platelet reactivity using the point-of-care VerifyNow P2Y12 assay. Elevated inflammatory status was defined as CRP >3 mg/L and HPR as P2Y12 reactivity units ≥240. The primary end point was the incidence of PMI in relation to platelet reactivity and/or inflammatory status. Rates of PMI were increased in patients with CRP levels >3 mg/L (10.9% vs 4.6% in those with normal levels, odds ratio 2.4, 95% confidence interval 1.2 to 4.5, p = 0.015) and in patients with HPR (11% vs 5.5% in those without HPR, odds ratio 2.2, 95% confidence interval 1.2-4.4, p = 0.018). The occurrence of PMI was highest in the subgroup with HPR and high inflammatory status (16.6% vs 3.6% in patients with CRP ≤3 mg/L and P2Y12 reactivity units <240, odds ratio 4.3, 95% confidence interval 1.5 to 12.6, p = 0.008). HPR in association with elevated CRP levels resulted in a significant increase in the discriminatory power of a model including clinical and procedural variables in predicting PMI (area under the curve 0.811, p = 0.041). In conclusion, in patients who undergo PCI, baseline stratification according to platelet reactivity and inflammatory status may identify those at higher risk for PMI.
在经皮冠状动脉介入治疗（PCI）后，高炎症状态和高治疗后血小板反应性（HPR）对围手术期心肌梗死（PMI）发生的增量预测价值尚未确定。本研究旨在评估在接受 PCI 的患者中，升高的 C 反应蛋白（CRP）水平和/或 HPR 与 PMI 发生率的相关性。对 500 例接受氯吡格雷治疗并行 PCI 的连续患者进行了术前 CRP 水平和血小板反应性的检测，使用即时检测的 VerifyNow P2Y12 检测法。炎症状态升高定义为 CRP>3mg/L，HPR 定义为 P2Y12 反应单位≥240。主要终点是与血小板反应性和/或炎症状态相关的 PMI 发生率。CRP 水平>3mg/L 的患者（10.9% vs 正常水平患者的 4.6%，优势比 2.4，95%置信区间 1.2 至 4.5，p=0.015）和 HPR 患者（11% vs 无 HPR 患者的 5.5%，优势比 2.2，95%置信区间 1.2 至 4.4，p=0.018）的 PMI 发生率增加。在 HPR 且炎症状态高的亚组中，PMI 的发生率最高（16.6% vs CRP≤3mg/L 且 P2Y12 反应单位<240 的患者 3.6%，优势比 4.3，95%置信区间 1.5 至 12.6，p=0.008）。HPR 与 CRP 水平升高相结合，可显著提高包含临床和手术变量的模型预测 PMI 的区分能力（曲线下面积 0.811，p=0.041）。总之，在接受 PCI 的患者中，根据血小板反应性和炎症状态进行基线分层可识别出发生 PMI 风险较高的患者。
