择期经皮冠状动脉介入术前氯吡格雷抵抗、植入支架的数目及长度与围手术期心肌损伤相关

目的 在择期行经皮冠状动脉介入术(percutaneous coronary intervention,PCI)的患者中,评价血栓弹力图(thrombelastography,TEG)检测的血小板活性及介入手术与围手术期心肌损伤(periprocedural myocardial injury,PMI)的关系.方法 选...

Clopidogrel resistance before selective percutaneous coronary intervention and the number and length of stents implanted were correlated with myocardial injury in perioperative period

Objective To evaluate the relationship between platelet activity as measured by thrombelastography (TEG) and interventional procedure and periprocedural myocardial injury (PMI) in patients undergoing selective percutaneous coronary intervention (PCI). Methods The data was collected from 378 patients of coronary heart disease (CHD) who received coronary arteriography (CAG) and stent implantation in Department of Cardiology, Zhongshan Hospital from Jan to Oct, 2017.After 12 hours of dual anti-platelet drug load, platelet reaction of the patients was measured by TEG.The number and length of stents in PCI were counted.Thrombin-induced maximum amplitude of clot strength (MA_Thrombin) reflected the intrinsic platelet activity, AA% and ADP% reflected the platelet inhibition rate of aspirin and clopidogrel, respectively. Results A total of 98 patients (25.9%) occurred PMI. Compared with the non-PMI group, the ADP% in PMI group was poor (48.5%±24.0% vs. 54.7%±25.9%, P=0.038).However, there was no significant difference between the two groups in the inhibitory rate of MA_Thrombin and AA%.Multi-factor Logistic regression revealed that age (OR=1.041, 95%CI:1.013-1.071, P=0.004), number of stents ≥ 3 (OR=3.009, 95%CI:1.590-5.694, P=0.001), length of stents ≥ 40 mm (OR=2.687, 95%CI:1.436-5.030, P=0.002) and ADP% (OR=0.990, 95%CI:0.980-0.999, P=0.040) are independent predictors of PMI occurrence. Conclusion PMI is a result mediated by multiple factors in patients undergoing selective coronary stenting. In addition to age, the number and length of stents implanted, the clopidogrel resistance were also independent risk factors for the occurrence of PMI.