Kukula Krzysztof, Klopotowski Mariusz, Was Joanna, Wrobel Aleksandra, Jamiolkowski Jacek, Debski Artur, Bekta Pawel, Chmielak Zbigniew, Witkowski Adam
Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
Department of Medical Biology, Institute of Cardiology, Warsaw, Poland.
Postepy Kardiol Interwencyjnej. 2017;13(3):210-217. doi: 10.5114/aic.2017.70188. Epub 2017 Sep 25.
There is ongoing controversy concerning the clinical value of platelet function monitoring in patients undergoing percutaneous coronary interventions (PCI). Patients at risk of high on-treatment platelet aggregation (HPR) may benefit most from such monitoring.
To define the factors related to HPR on aspirin and clopidogrel, looking at a wider spectrum of variables than those assessed in some previous studies.
We assessed platelet function in 908 patients on clopidogrel and aspirin after PCI using the multielectrode aggregometry system Multiplate to define which clinical, procedural and laboratory factors are related to on-treatment platelet aggregation in response to aspirin and clopidogrel either as linear values or using established cutoff values for HPR.
We found that in PCI patients on clopidogrel and aspirin, age (OR per year 1.06; 95% CI: 1.024-1.097; = 0.001), gender (OR = 0.319; 95% CI: 0.139-0.731; = 0.007), active smoking (OR = 2.57; 95% CI: 1.29-5.15; = 0.008), diabetes (β = 37.6; 95% CI: 16.5-58.8; = 0.001) and hypertension (β = 26.9; 95% CI: 6.73-47.1; = 0.009) are independently linked to platelet aggregation values treated as linear values and as dichotomous variables at the accepted cutoffs. The same is true for stented segment length (OR per mm 1.033; 95% CI: 1.010-1.057; = 0.009) and stent inflation pressure (OR per atmosphere 0.862; 95% CI: 0.772-0.963; = 0.002).
The study shows that, contrary to some earlier data, in the tested cohort women are better clopidogrel responders, but more often aspirin low-responders. Older age, active smoking, diabetes and hypertension all predispose to HPR. A novel finding is that stented segment length is an independent predictor of lower response both to aspirin and clopidogrel, possibly as a marker of more diffuse atherosclerosis.
对于接受经皮冠状动脉介入治疗（PCI）的患者，血小板功能监测的临床价值一直存在争议。有高治疗期血小板聚集（HPR）风险的患者可能从这种监测中获益最大。
确定与阿司匹林和氯吡格雷治疗相关的HPR因素，研究比以往一些研究所评估的更广泛的变量。
我们使用多电极凝集测定系统Multiplate评估了908例PCI术后服用氯吡格雷和阿司匹林患者的血小板功能，以确定哪些临床、手术和实验室因素与阿司匹林和氯吡格雷治疗期血小板聚集相关，将其作为线性值或使用既定的HPR临界值。
我们发现，在服用氯吡格雷和阿司匹林的PCI患者中，年龄（每年OR 1.06；95%CI：1.024 - 1.097；P = 0.001）、性别（OR = 0.319；95%CI：0.139 - 0.731；P = 0.007）、当前吸烟（OR = 2.57；95%CI：1.29 - 5.15；P = 0.008）、糖尿病（β = 37.6；95%CI：16.5 - 58.8；P = 0.001）和高血压（β = 26.9；95%CI：6.73 - 47.1；P = 0.009）独立与作为线性值以及在公认临界值下作为二分变量的血小板聚集值相关。支架植入段长度（每毫米OR 1.033；95%CI：1.010 - 1.057；P = 0.009）和支架膨胀压力（每大气压OR 0.862；95%CI：0.772 - 0.963；P = 0.002）情况相同。
该研究表明，与一些早期数据相反，在所测试的队列中，女性对氯吡格雷的反应更好，但更常是阿司匹林低反应者。年龄较大、当前吸烟、糖尿病和高血压均易导致HPR。一个新发现是，支架植入段长度是对阿司匹林和氯吡格雷反应较低的独立预测因素，可能作为更弥漫性动脉粥样硬化的一个标志。
