血小板-纤维蛋白凝块强度和血小板反应性预测经皮冠状动脉介入治疗后的心血管事件。

Platelet-fibrin clot strength and platelet reactivity predicting cardiovascular events after percutaneous coronary interventions.

机构信息

Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

Eur Heart J. 2024 Jul 9;45(25):2217-2231. doi: 10.1093/eurheartj/ehae296.

DOI:10.1093/eurheartj/ehae296

PMID:38804262

Abstract

BACKGROUND AND AIMS

Platelet-fibrin clot strength (PFCS) is linked to major adverse cardiovascular event (MACE) risk. However, the association between PFCS and platelet reactivity and their prognostic implication remains uncertain in patients undergoing percutaneous coronary intervention (PCI).

METHODS

In PCI-treated patients (n = 2512) from registry data from January 2010 to November 2018 in South Korea, PFCS using thromboelastography and platelet reactivity using VerifyNow were measured. High PFCS (PFCSHigh) was defined as thromboelastography maximal amplitude ≥ 68 mm, and high platelet reactivity (HPR) was defined as >208 P2Y12 reaction units. Patients were stratified into four groups according to maximal amplitude and P2Y12 reaction unit levels: (i) normal platelet reactivity (NPR)-PFCSNormal (31.8%), (ii) HPR-PFCSNormal (29.0%), (iii) NPR-PFCSHigh (18.1%), and (iv) HPR-PFCSHigh (21.1%). Major adverse cardiovascular event (all-cause death, myocardial infarction, or stroke) and major bleeding were followed up to 4 years.

RESULTS

High platelet reactivity and PFCSHigh showed an additive effect for clinical outcomes (log-rank test, P < .001). Individuals with NPR-PFCSNormal, NPR-PFCSHigh, HPR-PFCSNormal, and HPR-PFCSHigh demonstrated MACE incidences of 7.5%, 12.6%, 13.4%, and 19.3%, respectively. The HPR-PFCSHigh group showed significantly higher risks of MACE compared with the NPR-PFCSNormal group [adjusted hazard ratio (HRadj) 1.89; 95% confidence interval (CI) 1.23-2.91; P = .004] and the HPR-PFCSNormal group (HRadj 1.60; 95% CI 1.12-2.27; P = .009). Similar results were observed for all-cause death. Compared with HPR-PFCSNormal phenotype, NPR-PFCSNormal phenotype was associated with a higher risk of major bleeding (HRadj 3.12; 95% CI 1.30-7.69; P = .010).

CONCLUSIONS

In PCI patients, PFCS and platelet reactivity demonstrated important relationships in predicting clinical prognosis. Their combined assessment may enhance post-PCI risk stratification for personalized antithrombotic therapy.

摘要

背景与目的

血小板-纤维蛋白凝块强度（PFCS）与主要不良心血管事件（MACE）风险相关。然而，在接受经皮冠状动脉介入治疗（PCI）的患者中，PFCS 与血小板反应性之间的关联及其预后意义仍不确定。

方法

本研究纳入了 2010 年 1 月至 2018 年 11 月韩国注册数据中接受 PCI 治疗的 2512 例患者，使用血栓弹力图和 VerifyNow 测定 PFCS 和血小板反应性。高 PFCS（PFCSHigh）定义为血栓弹力图最大振幅≥68mm，高血小板反应性（HPR）定义为>208 P2Y12 反应单位。根据最大振幅和 P2Y12 反应单位水平，将患者分为四组：（i）正常血小板反应性（NPR）-PFCSNormal（31.8%）、（ii）HPR-PFCSNormal（29.0%）、（iii）NPR-PFCSHigh（18.1%）和（iv）HPR-PFCSHigh（21.1%）。随访 4 年，观察主要心血管事件（全因死亡、心肌梗死或卒中）和主要出血事件。

结果

高血小板反应性和 PFCSHigh 对临床结局具有累加效应（对数秩检验，P<0.001）。NPR-PFCSNormal、NPR-PFCSHigh、HPR-PFCSNormal 和 HPR-PFCSHigh 患者的 MACE 发生率分别为 7.5%、12.6%、13.4%和 19.3%。与 NPR-PFCSNormal 组相比，HPR-PFCSHigh 组发生 MACE 的风险显著升高[校正危险比（HRadj）1.89；95%置信区间（CI）1.23-2.91；P=0.004]，与 HPR-PFCSNormal 组相比，风险也显著升高[HRadj 1.60；95%CI 1.12-2.27；P=0.009]。全因死亡也观察到了类似的结果。与 HPR-PFCSNormal 表型相比，NPR-PFCSNormal 表型与主要出血风险升高相关[HRadj 3.12；95%CI 1.30-7.69；P=0.010]。