Jesselson Integrated Heart Center, Shaare Zedek Medical Center, The Herbrew University, Jerusalem, Israel; Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel-Aviv, Israel.
Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel-Aviv, Israel.
J Cardiol. 2021 Apr;77(4):375-379. doi: 10.1016/j.jjcc.2020.09.010. Epub 2020 Oct 13.
Platelet function testing (PFT) in patients treated with P2Y inhibitors has been widely evaluated for the prediction of stent thrombosis, myocardial infarction, and bleeding events following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). Thus, PFT-guided treatment could positively affect patient outcomes. Data regarding clinical parameters for predicting platelet reactivity in ACS patients are limited. Therefore, our study aims to evaluate CHADS2 and CHA2DS2-VASc scores as predictors for platelet reactivity in ACS patients.
Two hundred and ninety-one consecutive patients who underwent PCI and were treated with aspirin and clopidogrel due to ACS were tested for their CHADS2, CHA2DS2-VASc scores and platelet reactivity using adenosine diphosphate (ADP)-induced aggregation (conventional aggregometry). Patients were classified into groups according to their CHADS2 and CHA2DS2-VASc scores. Low-risk group (0-1 score) for CHADS2 and CHA2DS2-VASc scores and high-risk group (2-6, 2-9) for CHADS2 and CHA2DS2-VASc scores, respectively. Furthermore, platelet reactivity in each group were compared (low CHADS2 group vs high CHADS2 group, and low CHA2DS2-VASc vs high CHA2DS2-VASc). Platelet reactivity was defined as low platelet reactivity (<19 U), optimal platelet reactivity [(OPR); 19-46 U], and high on-treatment platelet reactivity [(HPR); >46 U]. Thereafter receiver operating characteristic curve analysis was conducted to verify whether CHADS2 and CHA2DS2-VASc scores could predict platelet reactivity.
Low CHADS2 and CHA2DS2-VASc scores were significantly correlated with lower mean platelet ADP-induced aggregation as compared with high CHADS2 and CHA2DS2-VASc scores [45.5 U (± 16) vs. 54.8 U (±15) and 44.2 U (±16) vs. 51.0 U (±17), respectively, p = 0.01 for both].
In ACS patients treated with clopidogrel following PCI, high CHADS2 and CHA2DS2-VASc scores correlated with HPR and lower scores correlated with OPR. Further studies are needed to evaluate our findings' clinical implications.
在接受 P2Y 抑制剂治疗的患者中进行血小板功能检测（PFT），已广泛评估其对急性冠脉综合征（ACS）经皮冠状动脉介入治疗（PCI）后支架血栓形成、心肌梗死和出血事件的预测作用。因此，PFT 指导治疗可能会对患者的结局产生积极影响。关于预测 ACS 患者血小板反应性的临床参数数据有限。因此，我们的研究旨在评估 CHADS2 和 CHA2DS2-VASc 评分作为 ACS 患者血小板反应性的预测指标。
连续 291 例因 ACS 而行 PCI 且接受阿司匹林和氯吡格雷治疗的患者，采用二磷酸腺苷（ADP）诱导的聚集（常规聚集测定法）检测其 CHADS2、CHA2DS2-VASc 评分和血小板反应性。根据 CHADS2 和 CHA2DS2-VASc 评分，将患者分为两组。低危组（0-1 分）和高危组（2-6 分，2-9 分）。此外，比较每组的血小板反应性（低 CHADS2 组与高 CHADS2 组，低 CHA2DS2-VASc 组与高 CHA2DS2-VASc 组）。血小板反应性定义为低血小板反应性（<19 U）、最佳血小板反应性[OPR；19-46 U]和治疗后高血小板反应性[HPR；>46 U]。随后进行受试者工作特征曲线分析，以验证 CHADS2 和 CHA2DS2-VASc 评分是否可预测血小板反应性。
低 CHADS2 和 CHA2DS2-VASc 评分与平均 ADP 诱导的血小板聚集明显相关，与高 CHADS2 和 CHA2DS2-VASc 评分相比，低 CHADS2 和 CHA2DS2-VASc 评分的平均 ADP 诱导的血小板聚集分别为[45.5 U（±16）比 54.8 U（±15）和 44.2 U（±16）比 51.0 U（±17），p 值均为 0.01]。
在接受 PCI 后接受氯吡格雷治疗的 ACS 患者中，高 CHADS2 和 CHA2DS2-VASc 评分与 HPR 相关，低评分与 OPR 相关。需要进一步研究来评估我们发现的临床意义。
