二磷酸腺苷诱导血小板聚集率与急性冠状动脉综合征患支架置入预后的关系

摘要

Objective This study sought to find out the relationship between platelet high reactivity and the incidence of major adverse cardiac event (MACE) after percutaneous coronary stenting with receiver-operating characteristic curve ( ROC) analysis. Methods A total of 278 patients with acute coronary syndrome (ACS) were observed for the incidence of perioperative myocardial infarction and MACE within a 6-month follow up. Measurment for adenosine diphosphate induced platelets aggregation ( ADP-PG) were also made. The results which include Perioperative myocardial infarction and MACE were analysed with ROC curve to find the optimal predictive value to definite high platelet reactivity patients. Results Patients with post-operation ADP-PG ≥47.5% were suggested as low platelet reactivity group according to ROC cure (area = 0. 66, 95% Cl 0. 57 - 0. 75 , P < 0. 01) and there were 81 patients recorded. A total of 39 cases presented MACE events in hospital and 6-months follow up. There were 4.6% (9/197) of patients with normal platelet reactivity and 11.1% (9/81) with low platelet reactivity presented MACE in 6-month follow up (P = 0.04, OR = 2. 61). Perioperative myocardial infarction between the two groups were 6. 6% and 14. 8% (P = 0. 03, OR = 2. 46) respectively and the difference of thrombotic events between the two groups are also statistically significant ( P = 0. 03). Conclusions Low post-treatment platelet response after PCI related to the high-incidence of ischemic events. The outcome prompted that monitoring of ADP-PG after PCI would be benefit to find out the high-risk patients.%目的 探讨以受试者工作特征曲线(ROC曲线)确定经皮冠状动脉介入治疗(PCI)术后高血小板聚集率(血小板低反应)与缺血性事件发生的关系.方法 入选278例急性冠脉综合征(ACS)患者于PCI术后及随访期1个月分别行二磷酸腺苷(ADP)诱导血小板聚集率(ADP-PG)检测,观察院内围术期心肌梗死及术后6个月随访期内主要不良心脏事件(MACE)；行ROC曲线分析,以最佳预测值分为血小板正常反应和血小板低反应组,观察组间MACE发生情况.结果 ROC曲线提示术后ADP-PG ≥47.5％为血小板低反应组(曲线下面积=0.66,95％ CI:0.57 ～0.75,P＜0.01),共有81例(29.1％)患者；院内及6个月随访期共发生MACE 39例(14.0％),随访期MACE发生率在血小板正常反应组和低反应组分别为4.6％ (9/197)和11.1％(9/81),OR =2.61,P=0.04,低反应组更容易出现MACE.围术期心肌梗死在两组间分别为6.6％(13/197)和14.8％(12/81),OR=2.46,P =0.03,血栓性事件在两组间差异有统计学意义(P=0.03).结论 术后血小板低反应与PCI术后缺血性事件高发生率相关,监测ADP-PG对发现PCI术后高危人群有帮助.