3rd Medical Department, Cardiology and Emergency Medicine .
Platelets. 2014;25(5):328-36. doi: 10.3109/09537104.2013.827781. Epub 2013 Aug 23.
Response to clopidogrel therapy is subject to inter-individual variability. However, data with regard to on-treatment platelet reactivity over time in patients undergoing coronary stenting are scarce. For this prospective observational study, 102 consecutive patients on dual antiplatelet therapy undergoing coronary stenting due to stable coronary artery disease (CAD; n = 29), non ST-elevation acute coronary syndrome (NSTE-ACS; n = 45) and ST-elevation myocardial infarction (STEMI; n = 28) were enrolled. Vasodilator-stimulated phosphoprotein-phosphorylation assay was performed at baseline, as well as 1, 3 and 6 months thereafter. Platelet reactivity index (PRI) measured after 1, 3 and 6 months was lower compared to baseline values (p < 0.001). Variables responsible for reduced response to clopidogrel at baseline (reticulated platelet fraction, simvastatin therapy) and during steady-state phase (body mass index, blood glucose concentrations, cholesterol/HDL-ratio and quality of life score) were different. High on-treatment platelet reactivity (HTPR)-phenotype (cut-off = 50% PRI) within the first month changed in 31% of stable CAD, 33% of NSTE-ACS and 39% of STEMI patients, respectively. HTPR-phenotype in the steady-state phase (month 1 to 6) changed in 45% of stable CAD, 33% of NSTE-ACS and 25% of STEMI patients. Response to clopidogrel and accordingly platelet function might vary over time, especially when a cut-off based approach, is used. There was a significant reduction of on-treatment platelet reactivity within the first month after percutaneous coronary intervention with stenting which was maintained for up to 6 months. Variables associated with reduced response to clopidogrel at baseline and during steady-state phase were different, as the latter mainly reflected an unfavorable metabolic profile, comprising elevated BMI, blood glucose levels as well as cholesterol/HDL-ratio.
对氯吡格雷治疗的反应存在个体间的差异。然而，关于接受冠状动脉支架置入术的患者随时间变化的治疗中血小板反应性的数据很少。在这项前瞻性观察研究中，连续招募了 102 例因稳定型冠状动脉疾病（CAD；n=29）、非 ST 段抬高型急性冠脉综合征（NSTE-ACS；n=45）和 ST 段抬高型心肌梗死（STEMI；n=28）而行冠状动脉支架置入术的双联抗血小板治疗患者。在基线时以及此后的 1、3 和 6 个月进行了血管扩张刺激磷蛋白磷酸化检测。与基线值相比，在 1、3 和 6 个月时测量的血小板反应指数（PRI）较低（p<0.001）。在基线时（网织血小板分数、辛伐他汀治疗）和稳定状态时（体重指数、血糖浓度、胆固醇/HDL 比值和生活质量评分）导致氯吡格雷反应降低的变量不同。在第一个月内，稳定型 CAD、NSTE-ACS 和 STEMI 患者中分别有 31%、33%和 39%的患者出现高治疗血小板反应性（HTPR）表型（cut-off=50% PRI）。在稳定状态期（第 1 个月至第 6 个月），稳定型 CAD、NSTE-ACS 和 STEMI 患者中分别有 45%、33%和 25%的患者出现 HTPR 表型改变。氯吡格雷的反应和相应的血小板功能可能随时间而变化，特别是当使用基于截止值的方法时。在经皮冠状动脉介入支架置入术后的第一个月内，治疗中血小板反应性显著降低，并持续至 6 个月。与基线和稳定状态时氯吡格雷反应降低相关的变量不同，因为后者主要反映了不利的代谢特征，包括体重指数升高、血糖水平升高以及胆固醇/HDL 比值升高。
