通过VerifyNow P2Y12检测评估的P2Y12反应单位与血小板抑制百分比的组合，是接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者长期临床结局的有用预测指标。
Combination of P2Y12 reaction unit and percentage of platelet inhibition assessed by VerifyNow P2Y12 assay is a useful predictor of long-term clinical outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
作者信息
Luo Yu, Li Jimin, Liu Xu, Xu Jianfeng, Ye Zi, Yao Yian, Liu Xuebo, Lai Yan
机构信息
Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China; Fudan Center for Genetic Epidemiology, School of Life Sciences, Fudan University, Shanghai, China.
出版信息
Thromb Res. 2016 Mar;139:114-20. doi: 10.1016/j.thromres.2016.01.020. Epub 2016 Jan 27.
INTRODUCTION
High on-treatment platelet reactivity is a well-known risk factor for adverse events in patients undergoing percutaneous coronary intervention (PCI). This study was to investigate the value of a novel platelet reactivity-based system, named the COP-INH (COmbination of P2Y12 reaction unit [PRU] and percentage of platelet inhibition [%INH]), assessed by VerifyNow P2Y12 assay, for predicting the long-term ischaemic events in patients with acute coronary syndrome (ACS) undergoing PCI.
MATERIALS AND METHODS
The COP-INH was calculated on the basis of data obtained at 30days after PCI: patients with both an elevated PRU (≥230) and decreased %INH (<40%) were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively. The primary endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization at 1year follow-up. The relationship between the COP-INH score and primary endpoint was analyzed.
RESULTS
207 patients were enrolled. Baseline characteristics were similar between patients with COP-INH=2 and patients with COP-INH=1 or 0, except for diabetes mellitus (43.8% vs. 21.7%, p=0.015) and previous coronary artery bypass grafting (CABG) (21.9% vs. 6.86%, p=0.007). During the observation period, the incidence of major adverse cardiovascular events (MACE) in patients with COP-INH=2 was significantly higher than patients with COP-INH=1 or 0 (18.8% vs. 4.6%, p=0.007). Multivariate analysis of clinical characteristics and platelet reactivity selected by univariate analysis showed that the COP-INH=2 was an independent predictor of MACE in patients with ACS undergoing PCI (OR 2.745; 95% CI 1.369-9.851; p=0.024), whereas neither PRU≥230 nor %INH<40% was.
CONCLUSION
The COP-INH is considered to be a useful predictor of long-term ischaemic events of patients with ACS undergoing PCI.
引言
高治疗期血小板反应性是接受经皮冠状动脉介入治疗（PCI）患者发生不良事件的一个众所周知的危险因素。本研究旨在探讨一种基于血小板反应性的新系统，即通过VerifyNow P2Y12检测评估的COP-INH（P2Y12反应单位[PRU]与血小板抑制百分比[%INH]的组合）对预测接受PCI的急性冠状动脉综合征（ACS）患者长期缺血事件的价值。
材料与方法
COP-INH根据PCI术后30天获得的数据计算得出：PRU升高（≥230）且%INH降低（<40%）的患者得分为2，表现出其中一项或均未表现出的患者分别得分为1或0。主要终点是1年随访时心血管死亡、非致命性心肌梗死和靶血管血运重建的复合终点。分析了COP-INH评分与主要终点之间的关系。
结果
共纳入207例患者。COP-INH = 2的患者与COP-INH = 1或0的患者基线特征相似，但糖尿病（43.8%对21.7%，p = 0.015）和既往冠状动脉旁路移植术（CABG）（21.9%对6.86%，p = 0.007）除外。在观察期内，COP-INH = 2的患者主要不良心血管事件（MACE）发生率显著高于COP-INH = 1或0的患者（18.8%对4.6%，p = 0.007）。对单因素分析选择的临床特征和血小板反应性进行多因素分析显示，COP-INH = 2是接受PCI的ACS患者MACE的独立预测因素（OR 2.745；95%CI 1.369 - 9.851；p = 0.024），而PRU≥230和%INH<40%均不是。
结论
COP-INH被认为是接受PCI的ACS患者长期缺血事件的有用预测指标。
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