体重指数对冠心病行经皮冠状动脉介入治疗术后患者血小板高反应性及长期预后的影响

目的:探讨体重指数(BMI)对冠心病行经皮冠状动脉介入治疗(PCI)后患者血小板高反应性(HTPR)及与长期预后的影响。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(TEG)检测结果的冠心病患者4 567例。血栓弹力图二磷酸腺苷诱导的纤维蛋白凝块强度(MAADP)大于47 mm定义为HTPR。所有患者根据BMI分为三组:正常体重组(18.5~24 kg/m^2,n=1 107)、超重组(24~28 kg/m^2,n=2 328)和肥胖组(≥28 kg/m^2,n=1132)。主要终点为2年主要不良心脑血管事件(MACCE)包括死亡、心肌梗死、血运重建、支架内血栓、脑卒中。结果:在行PCI的4 567例冠心病患者中,1 317(28.8%)例患者存在HTPR;三组(正常体重组、超重组和肥胖组)患者HTPR的发生率无明显差异(28.5%vs 29.3%vs 28.4%, P=0.818)。Logistic多因素分析显示HTPR仅与糖尿病相关,与BMI及其他因素无明显相关性。2年随访期间,三组患者MACCE差异亦无统计学意义(11.7%vs 10.7%vs 13.1%,P=0.109)。Cox多因素分析显示,HTPR并非MACCE的预测因子。结论:对于行PCI的冠心病患者,BMI与TEG所发现的HTPR无相关性;2年随访期间三组患者的MACCE发生率差异无统计学意义,且HTPR与患者预后无相关性。

Impact of Body Mass Index on High on-Treatment Platelet Reactivity and the Relationship With Clinical Prognosis in Coronary Heart Disease Patients Undergoing Percutaneous Coronary Intervention

Objectives: To investigate the impact of body mass index(BMI) on high on-treatment platelet reactivity(HTPR) and the relationship with clinical prognosis in patients with coronary heart disease(CHD) who underwent percutaneous coronary intervention.Methods: A total of 4 567 patients with coronary heart disease, who underwent stent implantation at Fuwai Hospital in 2013 and had 12-72 h postoperative thrombus elasticity data, were included in this study. Thrombosis Elasticity Maximum clot strength(MAADP) greater than 47 mm is defined as HTPR. All patients were divided into three groups according to BMI: normal body weight group(18.5 kg/m^2 ≤ BMI < 24 kg/m^2, n=1 107), overweight group(24 kg/m^2 ≤ BMI < 28 kg/m^2, n=2 328) and the obese group(BMI ≥ 28 kg/m^2, n=1 132). The primary endpoint was the 2-year major adverse cardiovascular and cerebrovascular event(MACCE) including death, myocardial infarction, revascularization, stent thrombosis, and stroke.Results: HTPR was detected in 1 317(28.8%) patients. There was no significant difference in the incidence of HTPR between the three groups(28.5% vs 29.3% vs 28.4%, P=0.818). Logistic multivariate analysis showed that HTPR was onlyassociated with diabetes and had no significant association with BMI and other factors. There were no significant differences in MACCE events between the three groups during the 2-year follow-up period(11.7% vs 10.7% vs 13.1%, P=0.109). COX multivariate analysis showed that HTPR is not a predictor of MACCE. Conclusions: In patients with coronary artery disease undergoing interventional therapy, there is no significant correlation between BMI and HTPR. There is also no significant difference in the incidence of MACCE between the patients with various BMI during the 2-year follow-up period and there is no significant correlation between HTPR and outcome of patients in this cohort.