血栓弹力图评价急性冠状动脉综合征患者介入术后血小板高反应性对不良预后影响分析

目的:探讨由血栓弹力图(TEG)测定二磷酸腺苷激活血小板形成最大血凝块强度(MAADP),评价急性冠状动脉综合征(ACS)经皮冠状动脉介入治疗术(PCI)后,与氯吡格雷治疗相关的血小板高反应性(HTPR)对预后的影响。方法:入选2011年1月至2012年9月,行PCI术的ACS患者360例。使用TEG检测其血小板的反应性,记录患者基线资料,并进行12个月随访,记录心脏不良事件的发生情况(全因性死亡、非致死性心肌梗死、再次血运重建及反复心绞痛导致再住院等)。结果:采用受试者工作特征(ROC)曲线分析TEG检测ACS患者HTPR的MA-ADP最佳界值47mm,并依此分组,HTPR组71例,NTPR组289例。与NTPR组相比,HTPR组女性(39.4%vs.23.9%,P0.05),非ST段抬高性心肌梗死(14.1%vs.5.5%,P0.05),糖尿病(45.1%vs.31.5%,P0.05),高敏C反应蛋白(3.2vs.1.4,P0.05),纤维蛋白原(3.2±0.7)vs.(2.9±0.7),P0.05]较高。Logistic回归显示女性、纤维蛋白原升高是TEG测定的HTPR的独立危险因素(OR=2.011,95%CI:1.144~3.533;OR=1.624,95%CI:1.122~2.350,P0.05);COX回归分析MAADP47mm是缺血事件的危险因素(HR=4.863,95%CI:2.505~9.439,P0.05)。结论:TEG测定的MAADP评价HTPR可预测ACS患者PCI术后再发缺血事件。

Prognostic impact of high on-treatment platelet reactivity measured by thrombeolastography on patients with acute coronary syndromes undergoing percutaneous coronary intervention

Objective：We evaluated prognostic impact of high on-clopidogrel treatment platelet reactivity（ HTPR） measured by thrombeolastography（ TEG） on patients with acute coronary syndromes（ ACS） undergoing percutaneous coronary intervention（ PCI）. Methods： 360 consecutive ACS patients following PCI were enrolled in this study. Platelet reactivity measured by TEG and the demographic characteristics were recorded.Ischemic and bleeding events were assessed over 1 year. The main end point was a composite of death,myocardial infarction,repeat revascularization,readmission and bleeding events. Results： By receiver operating characteristic curve analysis,MA-ADP N47 mm had the best pre- dictive value of long-term ischemic events. Patients were divided into two groups according to their MA-ADP as high on-treatment platelet reactivity group（ 71 patients with MAADP 47mm） and normal on-treatment platelet reactivity group（ 289 patients with MAADP 47mm）. HTPR group was more likely to be female（ 39. 4% vs. 23. 9%,P 0. 05）,NSTEMI（ 14. 1% vs.5. 5%,P 0. 05）,diabetes（ 45. 1% vs. 31. 5%,P 0. 05）,higher hs-CRP（ 3. 2vs. 1. 4,P 0. 05） and higher FBG （ 3. 2 ± 0. 7） vs.（ 2. 9 ± 0. 7）,P 0. 05]. Female and higher FBG were risk factors to HTPR（ OR is 2.011 and 1.624,P〈0.05）. The univariate Cox proportional hazards model identified MAADP N47 mm,as significant independent predictor of ischemic events at the 1-year time point,with hazard ratios of 4. 863（ 95%CI：2.505-9.439）,P〈0.05. Conclusion： MA-ADP measured by TEG evaluation of HTPR is significantly associated with higher risk of cardiovascular events in ACS patients following PCI.