冠心病介入术后性别对双联抗血小板治疗患者血小板反应性的影响

目的明确对于行经皮冠状动脉介入术(percutaneous coronary intervention,PCI)、服用双联抗血小板药物的冠心病患者血小板的反应性是否具有性别差异及对长期预后的影响。方法本研究纳入2013年1月至2013年12月于阜外医院行PCI且有术后12~72 h血栓弹力图检测结果的冠心病患者4606例,男3536例,女1070例。主要研究终点为2年主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events,MACCE:死亡、心肌梗死、靶血管或靶病变血运重建、脑卒中)及支架内血栓、大出血事件。结果通过对血栓弹力图的分析显示:男性、女性患者的花生四烯酸(arachidonic acid,AA)抑制率相似(81.0%±27.7%vs 79.7%±30.5%,P=0.178);男性二磷酸腺苷(adenosine diphosphate,ADP)抑制率高于女性(49.6%±31.2%vs 37.9%±31.2%,P<0.001);男性的二磷酸腺苷诱导的血小板纤维蛋白凝块强度(adenosine diphosphate-induced platelet-fibrin clot strength,MAADP)较女性更低[(32.6±17.1)mm vs(41.6±18.1)mm,P<0.001]。2年随访显示,男性、女性患者的MACCE发生率差异无显著性(8.5%vs 7.9%,P=0.377)。各单一主要终点事件中,男性患者死亡(1.2%vs 0.8%,P=0.045)及靶血管或靶病变血运重建(8.9%vs 6.4%,P=0.021)的发生率高于女性;其余单一主要终点事件无显著性差异。COX回归模型分析显示,MAADP并非MACCE及各单一主要终点事件的独立预测因素。结论2年随访显示,男性患者死亡及靶血管或靶病变血运重建的发生率高于女性,但MACCE发生率差异无显著性;MAADP并非是MACCE及各单一主要终点事件的独立预测因素。

Effect of gender difference on platelet reactivity in patients with dual antiplatelet therapy after percutaneous coronary intervention

Objective To determine whether there are gender differences in platelet reactivity and long-term prognosis in patients undergoing percutaneous coronary intervention(PCI)and taking dual antiplatelet drugs.Methods A total of 4606 patients with coronary heart disease who underwent PCI in Fuwai Hospital from January 2013 to December 2013 and had thromboelastogram results were enrolled in this study.There were 3536 males and 1070 females.The main endpoints were 2 years of major adverse cardio-cerebrovascular events(MACCE:death,myocardial infarction,target vessel or lesion revascularization,stroke),stent thrombosis and massive hemorrhage.Results The analysis of thromboelastogram showed that the AA inhibition rate of male and female patients was similar(81.0%±27.7%vs 79.7%±30.5%,P=0.178);the ADP inhibition rate of male patients was higher than that of female patients(49.6%±31.2%vs 37.9%±31.2%,P<0.001);and the MAADP of male patients was lower than that of female patients([32.6±17.1]mm vs[41.6±18.1]mm,P<0.001).After two years of follow-up,there was no significant difference in the incidence of M ACCE between male and female patients(8.5%vs 7.9%,P=0.377).The incidence of death(1.2%vs 0.8%,P=0.045)and revascularization(8.9%vs 6.4%,P=0.021)was higher in males than in females.There was no significant difference in other single major endpoint events.COX regression analysis shows that MAADP was not an independent predictor of MACCE or single major endpoint events.Conclusion For patients with coronary heart disease undergoing PCI,the inhibition rate of ADP in males is higher than that in females,the MAADP of male patients is lower than that of female patients.After two years of follow-up,there is no significant difference in the incidence of MACCE between male and female patients;the incidence of death and revascularization in male patients is higher than that in female patients.MAADP is not an independent predictor of MACCE or single major endpo int events.