Department of Cardiology, National University Heart Centre, Singapore, Singapore.
Department of Cardiology, Albert Einstein Hospital, Sao Paolo, Sao Paolo, Brazil.
Thromb Haemost. 2018 Feb;118(2):415-426. doi: 10.1160/TH17-08-0564. Epub 2018 Jan 29.
Studies on platelet reactivity (PR) testing commonly test PR only after percutaneous coronary intervention (PCI) has been performed. There are few data on pre- and post-PCI testing. Data on simultaneous testing of aspirin and adenosine diphosphate antagonist response are conflicting. We investigated the prognostic value of combined serial assessments of high on-aspirin PR (HASPR) and high on-adenosine diphosphate receptor antagonist PR (HADPR) in patients with acute coronary syndrome (ACS). HASPR and HADPR were assessed in 928 ACS patients before (initial test) and 24 hours after (final test) coronary angiography, with or without revascularization. Patients with HASPR on the initial test, compared with those without, had significantly higher intraprocedural thrombotic events (IPTE) (8.6 vs. 1.2%, ≤ 0.001) and higher 30-day major adverse cardiovascular and cerebrovascular events (MACCE; 5.2 vs. 2.3%, = 0.05), but not 12-month MACCE (13.0 vs. 15.1%, = 0.50). Patients with initial HADPR, compared with those without, had significantly higher IPTE (4.4 vs. 0.9%, = 0.004), but not 30-day (3.5 vs. 2.3%, = 0.32) or 12-month MACCE (14.0 vs. 12.5%, = 0.54). The c-statistic of the Global Registry of Acute Coronary Events (GRACE) score alone, GRACE score + ASPR test and GRACE score + ADPR test for discriminating 30-day MACCE was 0.649, 0.803 and 0.757, respectively. Final ADPR was associated with 30-day MACCE among patients with intermediate-to-high GRACE score (adjusted odds ratio [OR]: 4.50, 95% confidence interval [CI]: 1.14-17.66), but not low GRACE score (adjusted OR: 1.19, 95% CI: 0.13-10.79). In conclusion, both HASPR and HADPR predict ischaemic events in ACS. This predictive utility is time-dependent and risk-dependent.
研究表明，血小板反应性（PR）检测通常在经皮冠状动脉介入治疗（PCI）后进行。关于 PCI 前后检测的数据较少。同时检测阿司匹林和二磷酸腺苷拮抗剂反应的数据存在冲突。我们研究了急性冠状动脉综合征（ACS）患者在冠状动脉造影前后（初始测试和最终测试）连续评估高阿司匹林反应性血小板（HASPR）和高二磷酸腺苷受体拮抗剂反应性血小板（HADPR）的预后价值。在接受或不接受血运重建的 928 例 ACS 患者中，在冠状动脉造影前（初始测试）和 24 小时后（最终测试）评估 HASPR 和 HADPR。与无 HASPR 的患者相比，有 HASPR 的患者在初始测试中发生术中血栓形成事件（IPTE）的比例明显更高（8.6%对 1.2%，≤0.001），30 天内发生主要不良心血管和脑血管事件（MACCE）的比例也更高（5.2%对 2.3%，=0.05），但 12 个月时的 MACCE 发生率无差异（13.0%对 15.1%，=0.50）。与无 HADPR 的患者相比，有 HADPR 的患者发生 IPTE 的比例明显更高（4.4%对 0.9%，=0.004），但 30 天（3.5%对 2.3%，=0.32）和 12 个月 MACCE 发生率无差异（14.0%对 12.5%，=0.54）。单独的全球急性冠状动脉事件注册（GRACE）评分、GRACE 评分+ASPR 试验和 GRACE 评分+ADPR 试验预测 30 天 MACCE 的曲线下面积分别为 0.649、0.803 和 0.757。对于中高危 GRACE 评分的患者，最终 ADPR 与 30 天 MACCE 相关（校正优势比 [OR]：4.50，95%置信区间 [CI]：1.14-17.66），而对于低 GRACE 评分的患者则不相关（校正 OR：1.19，95% CI：0.13-10.79）。总之，HASPR 和 HADPR 均能预测 ACS 中的缺血事件。这种预测效用是时间依赖性和风险依赖性的。
