Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
Adv Ther. 2021 Jun;38(6):3077-3088. doi: 10.1007/s12325-021-01749-z. Epub 2021 Apr 29.
Both thyroid dysfunction and low responsiveness to clopidogrel have been reported to be associated with increased cardiovascular risk. Our study aims at determining the relationship between free triiodothyronine (FT3) and low responsiveness to clopidogrel in patients undergoing elective percutaneous coronary intervention (PCI).
Consecutive patients undergoing elective PCI were enrolled. All patients received a loading dose of 300 mg clopidogrel, and platelet function was assessed by thromboelastography at least 12 h later. Low responsiveness to clopidogrel was defined by an adenosine diphosphate-induced platelet-fibrin clot strength > 47 mm and adenosine diphosphate-induced platelet inhibition rate < 50%. Major adverse cardiovascular events (MACEs) were defined as a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and ischemia-driven revascularization.
Of 812 patients included in the study, 289 showed low responsiveness to clopidogrel. The FT3 level was significantly lower in low responders (4.61 ± 0.60 pmol/l versus 4.94 ± 4.66 pmol/l, p = 0.002). Moreover, the percentage of low responders was greater among patients with low FT3 level than among those without (56.1% versus 34.5%, p = 0.007). Logistic regression analysis showed that a FT3 level was independently associated with the risk of low responsiveness to clopidogrel (odds ratio 0.720, 95% confidence interval [CI] 0.533-0.973, p = 0.033). In patients with low responsiveness to clopidogrel, low FT3 was independently associated with increased risk of MACEs (adjusted hazard ratio 3.040, 95% CI 1.077-8.580, p = 0.036) at a median of 19-month follow-up.
Low FT3 was independently associated with increased risks of both low responsiveness to clopidogrel and cardiovascular events in patients undergoing elective PCI.
甲状腺功能障碍和对氯吡格雷反应低下均与心血管风险增加有关。我们的研究旨在确定接受选择性经皮冠状动脉介入治疗（PCI）的患者中游离三碘甲状腺原氨酸（FT3）与对氯吡格雷反应低下之间的关系。
连续纳入接受选择性 PCI 的患者。所有患者均接受氯吡格雷负荷剂量 300mg，至少 12 小时后通过血栓弹力图评估血小板功能。低反应性氯吡格雷定义为二磷酸腺苷诱导的血小板-纤维蛋白凝块强度>47mm 和二磷酸腺苷诱导的血小板抑制率<50%。主要不良心血管事件（MACE）定义为心血管死亡、非致死性心肌梗死、非致死性卒中和缺血驱动的血运重建的复合事件。
在纳入的 812 例患者中，289 例对氯吡格雷反应低下。低反应者的 FT3 水平明显降低（4.61±0.60pmol/l 比 4.94±0.66pmol/l，p=0.002）。此外，FT3 水平低的患者中低反应者的比例高于 FT3 水平正常的患者（56.1%比 34.5%，p=0.007）。Logistic 回归分析显示，FT3 水平与对氯吡格雷反应低下的风险独立相关（比值比 0.720，95%置信区间 [CI] 0.533-0.973，p=0.033）。在对氯吡格雷反应低下的患者中，低 FT3 与 MACE 风险增加独立相关（调整后的危险比 3.040，95%CI 1.077-8.580，p=0.036），中位随访时间为 19 个月。
在接受选择性 PCI 的患者中，低 FT3 与对氯吡格雷反应低下和心血管事件的风险增加独立相关。
