Valenti Renato, Cantini Giulia, Marcucci Rossella, Marrani Marco, Migliorini Angela, Carrabba Nazario, Comito Vincenzo, Vergara Ruben, Cerisano Giampaolo, Parodi Guido, Abbate Rosanna, Gori Anna Maria, Gensini Gian Franco, Antoniucci David
Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Department of Heart and Vessels, Careggi Hospital, Florence, Italy; Post-graduate School in Cardiology, University of Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Italy.
Int J Cardiol. 2015 Dec 15;201:561-7. doi: 10.1016/j.ijcard.2015.04.052. Epub 2015 Apr 10.
The study sought to determine the impact of high residual platelet reactivity (HRPR) on long-term cardiac mortality in diabetic patients treated with PCI for CTO. No data exist about the impact of HRPR after 600 mg clopidogrel loading on long-term clinical outcome in patients with diabetes mellitus and treated with percutaneous coronary angioplasty (PCI) for chronic total occlusion (CTO).
From the Florence CTO-PCI registry, we identified consecutive diabetic patients with available in vitro platelet reactivity assessment by light transmittance aggregometry after a loading dose of 600 mg of clopidogrel. HRPR was defined as residual platelet aggregation by 10 μmol/L ADP test ≥70%. The primary end point of the study was long-term cardiac mortality.
Two-hundred and three diabetic patients underwent CTO-PCI. The incidence of HRPR was 23%. The 3-year cardiac survival was lower in the HRPR group than the low residual platelet reactivity (LRPR) group (70 ± 7% and 92 ± 3%, respectively; p=0.001). Within the oral antidiabetic patients there were no significant differences in long-term survival between HRPR and LRPR groups. Conversely, the association of insulin therapy and HRPR was related to a dramatic decrease in survival compared to the LRPR group (34 ± 14% vs. 89 ± 4%; p<0.001). At multivariable analysis insulin therapy (HR 4.31; p=0.001) and HRPR (HR 3.26; p=0.004) were significantly related to long-term mortality, while completeness of revascularization was inversely related to cardiac mortality (HR 0.40; p=0.029).
HRPR is a strong marker of increased risk of cardiac death in patients with DM who underwent PCI for CTO.
本研究旨在确定高残余血小板反应性（HRPR）对接受CTO经皮冠状动脉介入治疗（PCI）的糖尿病患者长期心脏死亡率的影响。关于600mg氯吡格雷负荷剂量后HRPR对糖尿病患者并接受慢性完全闭塞（CTO）经皮冠状动脉成形术（PCI）长期临床结局的影响，目前尚无相关数据。
从佛罗伦萨CTO-PCI注册研究中，我们识别出连续的糖尿病患者，这些患者在接受600mg氯吡格雷负荷剂量后，通过透光率聚集法进行了体外血小板反应性评估。HRPR定义为10μmol/L ADP试验中残余血小板聚集率≥70%。本研究的主要终点是长期心脏死亡率。
203例糖尿病患者接受了CTO-PCI治疗。HRPR的发生率为23%。HRPR组的3年心脏生存率低于低残余血小板反应性（LRPR）组（分别为70±7%和92±3%；p=0.001）。在口服抗糖尿病药物治疗的患者中，HRPR组和LRPR组的长期生存率无显著差异。相反，与LRPR组相比，胰岛素治疗与HRPR的联合与生存率的显著下降相关（34±14%对89±4%；p<0.001）。在多变量分析中，胰岛素治疗（HR 4.31；p=0.001）和HRPR（HR 3.26；p=0.004）与长期死亡率显著相关，而血管重建的完整性与心脏死亡率呈负相关（HR 0.40；p=0.029）。
HRPR是接受CTO PCI治疗的糖尿病患者心脏死亡风险增加的有力标志物。
