Gao Xiao-Fei, Lu Shu, Ge Zhen, Zuo Guang-Feng, Wang Zhi-Mei, Wang Feng, Kong Xiang-Quan, Chai Da-Yang, Chen Shao-Liang, Zhang Jun-Jie
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, China.
Department of Cardiology, The First People's Hospital of Taicang, Suzhou, China.
BMC Cardiovasc Disord. 2018 May 24;18(1):103. doi: 10.1186/s12872-018-0841-1.
The relationship between platelet reactivity and long-term clinical outcomes remains controversial. The present prospective study was designed to explore the association between high platelet reactivity (HPR) on clopidogrel and long-term clinical outcomes following implantation of drug eluting stents (DES).
A total of 1769 consecutive patients assessed by Aggrestar (PL-11) were enrolled at our center from February 2011 to December 2017. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCE), defined as definite or probable stent thrombosis, spontaneous myocardial infarction, all cause death, clinically driven target vessel revascularization (TVR), or ischemic stroke. Bleeding served as the safety endpoint. Propensity score matching (PSM) analysis was performed to adjust for baseline differences in the overall cohort.
Finally, 409 patients (23.1%) were identified with HPR on clopidogrel. At a median follow-up of 4.1 years (interquartile range, 1.8 years), the occurrence of MACCE was significantly higher in HPR on clopidogrel group than normal platelet reactivity (NPR) on clopidogrel group (15.6% vs. 5.4%, p < 0.001). After PSM, 395 paired patients were matched, and the difference in MACCE between HPR (15.7%) versus NPR (9.4%) on clopidogrel groups remained significant (P < 0.001), mainly driven by increased all cause death (5.3% vs. 1.8%, p < 0.001), and clinically driven TVR (8.1% vs. 6.3%, p = 0.019) in the HPR group. The risk of bleeding between two groups was similar.
This prospective study confirms the relationship between HPR on clopidogrel and long-term adverse cardiovascular events after coronary stenting.
血小板反应性与长期临床结局之间的关系仍存在争议。本前瞻性研究旨在探讨氯吡格雷治疗下的高血小板反应性（HPR）与药物洗脱支架（DES）植入术后长期临床结局之间的关联。
2011年2月至2017年12月期间，在我们中心共纳入了1769例通过Aggrestar（PL - 11）评估的连续患者。主要终点是主要不良心血管和脑血管事件（MACCE），定义为明确或可能的支架血栓形成、自发性心肌梗死、全因死亡、临床驱动的靶血管血运重建（TVR）或缺血性卒中。出血作为安全性终点。进行倾向评分匹配（PSM）分析以调整总体队列中的基线差异。
最终，409例患者（23.1%）被确定为氯吡格雷治疗下的HPR。在中位随访4.1年（四分位间距，1.8年）时，氯吡格雷治疗下的HPR组MACCE的发生率显著高于氯吡格雷治疗下的正常血小板反应性（NPR）组（15.6%对5.4%，p < 0.001）。PSM后，匹配了395对患者，氯吡格雷治疗下的HPR组（15.7%）与NPR组（9.4%）之间的MACCE差异仍然显著（P < 0.001），主要是由于HPR组全因死亡增加（5.3%对1.8%，p < 0.001）以及临床驱动的TVR增加（8.1%对6.3%，p = 0.019）。两组之间的出血风险相似。
这项前瞻性研究证实了氯吡格雷治疗下的HPR与冠状动脉支架置入术后长期不良心血管事件之间的关系。
