Bernlochner Isabell, Jaitner Juliane, Fries Verena, Dommasch Michael, Mayer Katharina, Ott Ilka, Langwieser Nicolas, Fusaro Massimiliano, Laugwitz Karl-Ludwig, Kastrati Adnan, Ibrahim Tareq
1 I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
2 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Vasa. 2016;45(2):155-61. doi: 10.1024/0301-1526/a000510.
High on-treatment platelet reactivity (HPR) predicts adverse cardiovascular events in patients with coronary artery disease. The impact of HPR in patients with peripheral artery disease (PAD) after peripheral endovascular procedures is unclear.
A total of 385 patients with PAD and successful percutaneous endovascular procedure were included. Patients received aspirin as a long-term treatment in addition to the P2Y12 receptor antagonist clopidogrel, as recommended after such a procedure for at least 1 month. Platelet function was assessed on a Multiplate analyzer. The primary endpoint was target lesion revascularization (TLR) at one year. Restenosis (≥ 75 %) in duplex sonography, mortality at one year and identification of independent predictors of TLR were secondary endpoints.
TLR rates were similar in HPR and no-HPR patients (14.3 % vs. 12.7 %, hazard rate (HR) 0.94, 95 % CI 0.48 - 1.84, P = 0.86). Restenosis (≥ 75 %) in duplex sonography did not differ between the two study groups (15.6 % vs. 16.9 %, HR 1.16, 95% CI 0.62 - 2.12, P = 0.64). Independent predictors of TLR were intervention of restenotic lesions, total vessel occlusions and critical limb ischemia, but not HPR (adjusted HR 1.07, 95% CI 0.55 - 2.10, P = 0.84). No difference in mortality at one year was observed (1.3 % vs. 1.6 %, HR 1.28, 95 % CI 0.15 - 11.0, P = 0.82).
In patients with PAD, HPR did not have a significant impact on outcomes within the first year after percutaneous endovascular intervention.
治疗期间高血小板反应性（HPR）可预测冠状动脉疾病患者发生不良心血管事件。HPR对接受外周血管腔内治疗术后的外周动脉疾病（PAD）患者的影响尚不清楚。
共纳入385例成功接受经皮血管腔内治疗的PAD患者。按照此类手术后的推荐，患者除接受P2Y12受体拮抗剂氯吡格雷治疗外，还接受阿司匹林长期治疗，至少持续1个月。使用多电极血小板功能分析仪评估血小板功能。主要终点为1年时的靶病变血运重建（TLR）。双功超声检查中的再狭窄（≥75%）、1年时的死亡率以及TLR独立预测因素的识别为次要终点。
HPR患者和非HPR患者的TLR发生率相似（14.3%对12.7%，风险率[HR]0.94，95%置信区间[CI]0.48 - 1.84，P = 0.86）。双功超声检查中的再狭窄（≥75%）在两个研究组之间无差异（15.6%对16.9%，HR 1.16，95%CI 0.62 - 2.12，P = 0.64）。TLR的独立预测因素为再狭窄病变干预、血管完全闭塞和严重肢体缺血，而非HPR（校正HR 1.07，95%CI 0.55 - 2.10，P = 0.84）。1年时的死亡率无差异（1.3%对1.6%，HR 1.28，95%CI 0.15 - 11.0，P = 0.82）。
在PAD患者中，HPR对经皮血管腔内干预术后第一年内的结局无显著影响。
