残余血小板高反应性可增加PCI术后围术期心肌梗死的发生风险

摘要

目的：探讨氯吡格雷治疗后残余血小板高反应性（HPR）与PCI术后围术期心肌梗死（PMI）的相关性。方法入选283例行择期PCI患者，术前口服氯吡格雷300 mg，术后24小时内通过血栓弹力图检测ADP抑制率，ADP抑制率≤20%即HPR；比较PMI组和非PMI组基线情况，并进行Logistic回归分析。结果 PMI组ADP抑制率更低（36±29.8% vs 43.9±26.4%，P=0.02），同时HPR比例也更高（39.8% vs 22.0%，P=0.01）；经Logistic回归分析，HPR是PMI的危险因素（OR=2.94，95%CI 1.42-6.09，P＜0.05）。结论 HPR可增加择期PCI术后PMI的发生风险。%Objective To explore the association of the high platelet reactivity after clopidogrel loading (HPR) with perioperative myocardial infarction(PMI) after percutaneous coronary intervention(PCI).MethodsA total of 283 patients with coronary heart disease underging elective PCI were included. Platelet reactivity was assessed by Thrombelastograph at 24 h after 300mg clopidogrel loading. HPR was defined ADP inhibition rate≤ 20%. To Compare the baseline clinical characteristics between PMI and without PMI.ResultsADP inhibition rate was lower in patients with PMI than in those without PMI (36 ± 29.8% vs 43.9 ± 26.4%,P=0.02);HPR was more frequently observed in patients with PMI(39.8% vs. 22.0%,P=0.01),and HPR was a risk factor of PMI (OR=2.94, 95%CI 1.42-6.09,P<0.05). Conclusion Among the studied patients, HPR is associated with an increased risk for PMI.