Objective To evaluate clopidogrel resistance in patients who underwent primary percutaneous coronary intervention (PPCI) and the relationship with the no-reflow phenomenon.Methods From January 2009 to December 2011,765 acute myocardial infarction patients undergoing PPCI were enrolled in this study.Clopidogrel resistance defined according to ADP induced maximal platelet aggregation rate; the patients were divided into no reflow group and control group.The clinical data were compared to analyze the clopidogrel resistance contributing to no reflow.Results Male,the history of hypertension,smoking,time to admission,the count of platelet and white blood cell,IRA,stent diameter and door-balloon time showed no differences between two groups.Compared with the control group,age(62 ± 10 vs 60 ± 11,P =0.032),diabetes mellitus [29.6％ (24/81) vs 19.9％ (136/684),P =0.044],the occurrence of clopidogrel resistance[38.3％ (31/81) vs 24.9％ (170/684),P =0.011],thrombolysis in myocardial infarction flow grade 0 pre-procedure [82.7 ％ (67/81) vs 70.5 ％ (482/684),P =0.026],using of tirofiban [42.0％ (34/81) vs 30.8 ％ (211/684),P =0.045],the peak of cardial troponin Ⅰ [(58 ± 14)μg/L vs (54±13) μg/L,P=0.015],creatine kinase isoenzyme [(156 ±42)U/L vs (145 ±40) U/L,P=0.027] and creatine kinase [(1437 ±202) U/L vs(1388 ±216) U/L,P =0.041] and mortality[4.9％ (4/81)vs 1.0 ％ (7/684),P =0.022] were increased significantly; the incidence of ST resolution [66.7％ (54/81) vs 82.5％(564/684),P=0.001] and left ejection fraction [(48 ±11)％ vs (51 ±11)％,P=0.028]were decreased in no-roflow group.Logistic analysis showed that clopidogrel resistance was an independent factor of no-reflow during PPCI.Conclusion Clopidogrel resistance may be one of the responsible mechanisms for the no-reflow phenomenon.%目的 观察氯吡格雷抵抗与急性心肌梗死(AMI)患者直接经皮冠状动脉介入(PPCI)术中无复流的关系.方法 入选2009年1月至2010年12月因AMI住院行PPCI术患者共765例,所有患者术后5d晨起空腹采血,根据对二磷酸腺苷诱导的血小板聚集抑制率判定是否出现氯吡格雷抵抗.根据术中是否出现无复流分为无复流组(81例)和对照组(684例),比较2组临床特点,分析氯吡格雷抵抗与术中出现无复流的关系.结果 2组男性比、高血压患病率、吸烟情况、发病至就诊时间、白细胞计数、血小板计数、梗死相关动脉、支架直径、门-球时间差异无统计学意义(P＞0.05).与对照组比较,无复流组糖尿病患病率[(29.6％ (24/81)比19.9％ (136/684),P=0.044]、年龄[(62±10)岁比(60±11)岁,P=0.032]、氯吡格雷抵抗发生率[38.3％(31/81)比24.9％ (170/684),P=0.011]、术前心肌梗死溶栓试验血流0级[82.7％(67/81)比70.5％ (482/684),P=0.026]、应用替罗非班者占比[42.0％ (34/81)比30.8％ (211/684),P=0.045]、肌钙蛋白Ⅰ(cTn Ⅰ)峰值[(58±14) μg/L比(54±13) μg/L,P=0.015]、肌酸激酶同工酶(CK-MB)峰值[(156±42) U/L比(145±40) U/L,P=0.027]、肌酸激酶(CK)峰值(1437±202) U/L比(1388±216)U/L,P=0.041]、病死率[4.9％ (4/81)比1.0％ (7/684),P=0.022]明显升高,ST段回落率[66.7％ (54/81)比82.5％ (564/684),P=0.001]及左心室射血分数(LVEF)[(48±11)％比(51±11)％,P=0.028]则明显下降.Logistic回归分析结果显示,在校正了其他危险因素之后,氯吡格雷抵抗是PPCI术中出现无复流的独立影响因素(比值比=3.466,95％置信区间:1.447～10.876,P=0.019).结论 氯吡格雷抵抗是PPCI术中出现无复流的可能机制之一,严重影响预后.
展开▼
