Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini 5, 80131 Naples, Italy.
Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini 5, 80131 Naples, Italy.
Atherosclerosis. 2014 May;234(1):176-84. doi: 10.1016/j.atherosclerosis.2014.02.024. Epub 2014 Mar 11.
High on-treatment platelet reactivity (HPR) is a well-known risk factor for adverse events in patients undergoing percutaneous coronary intervention (PCI). However, whether reducing platelet reactivity can lead to a lower incidence of ischemic events after PCI is still controversial. Therefore, we sought to investigate this issue by a meta-regression analysis of randomized trials.
We collected randomized trials reporting HPR rates in patients receiving different antiplatelet therapies. ΔHPR was defined as the difference between HPR rates achieved in control vs. experimental arms, and the relationship between ΔHPR and clinical outcomes was evaluated.
Thirty trials totalling 6683 patients with a mean follow-up of 3-month were included. Reducing platelet reactivity was associated to a decreased risk of major adverse cardiac events (MACE), with a linear relationship between ΔHPR and MACE (change in tau(2) = -2.50; p = 0.023). Particularly, achieving a 10% difference in HPR rates resulted in a parallel risk reduction in MACE of about 11% (Exp((b)) = 0.98; 95% CI, 0.97-0.99). Changes in HPR predict the risk of ischemic events in patients with acute coronary syndrome (change in tau(2) = -2.52; Exp((b)) = 0.98; 95% CI, 0.97-0.99; p = 0.03), but not in patients with poor response to clopidogrel (change in tau(2) = -1.44; Exp((b)) = 0.98; 95% CI, 0.96-1.01; p = 0.19) or stable coronary artery disease (change in tau(2) = -0.14; Exp((b)) = 0.99; 95% CI, 0.94-1.05; p = 0.89).
Reducing HPR occurrence decreases the risk of ischemic events in patients with acute coronary syndrome undergoing PCI, whereas a strategy of reducing platelet reactivity does not improve clinical outcomes in patients with poor response to clopidogrel or stable coronary artery disease.
治疗中血小板高反应性（HPR）是经皮冠状动脉介入治疗（PCI）患者不良事件的一个众所周知的危险因素。然而，降低血小板反应性是否能降低 PCI 后的缺血事件发生率仍存在争议。因此，我们通过对随机试验的荟萃回归分析来研究这个问题。
我们收集了报告接受不同抗血小板治疗的患者 HPR 发生率的随机试验。ΔHPR 定义为对照组与实验组之间 HPR 率的差异，评估 ΔHPR 与临床结果之间的关系。
共纳入 30 项试验，总计 6683 例患者，平均随访 3 个月。降低血小板反应性与主要不良心脏事件（MACE）风险降低相关，ΔHPR 与 MACE 之间呈线性关系（变化 tau(2) = -2.50；p = 0.023）。特别是，HPR 率降低 10%，MACE 风险降低约 11%（Exp((b)) = 0.98；95%CI，0.97-0.99）。HPR 的变化可预测急性冠状动脉综合征患者的缺血事件风险（变化 tau(2) = -2.52；Exp((b)) = 0.98；95%CI，0.97-0.99；p = 0.03），但不能预测氯吡格雷反应不良患者（变化 tau(2) = -1.44；Exp((b)) = 0.98；95%CI，0.96-1.01；p = 0.19）或稳定型冠状动脉疾病患者（变化 tau(2) = -0.14；Exp((b)) = 0.99；95%CI，0.94-1.05；p = 0.89）的缺血事件风险。
降低 HPR 发生率可降低 PCI 后急性冠状动脉综合征患者的缺血事件风险，而降低血小板反应性的策略并不能改善氯吡格雷反应不良或稳定型冠状动脉疾病患者的临床结局。
