Clinical Significance of Laboratory-determined Aspirin Poor Responsiveness After Primary Percutaneous Coronary Intervention
Clinical Significance of Laboratory-determined Aspirin Poor Responsiveness After Primary Percutaneous Coronary Intervention
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DOI：
10.1007/s10557-016-6643-8
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发表时间：
2016-04-01
影响因子：
3.4
通讯作者：
Marinkovic, Jelena
中科院分区：
文献类型：
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作者：
Mrdovic, Igor;Colic, Mirko;Marinkovic, Jelena
目的探讨阿司匹林反应性差/高反应性(APR/AHR)与急性ST段抬高急性心肌梗死患者直接经皮冠状动脉介入治疗(PPCI)后主要心血管事件(MACE)和严重出血发生率的相关性。多平板分析仪(德国慕尼黑戴纳比特)用于评估血小板的反应性。APR/AHR定义为ASPI值的上/下五分位数，在阿司匹林负荷后24小时测定。APR患者按300 mg维持量量身定做，疗程30天。根据BARC分类，30天的共同主要终点是：MACE(死亡、非致命性脑梗塞、缺血驱动的靶血管重建和缺血性卒中)和严重出血。结果APR 190例，AHR 193例。入院时，与阿司匹林敏感患者(ASP)相比，APR患者糖尿病、前壁梗死和心力衰竭的发生率更高，而AHR患者的肌酸激酶、白细胞、心率和收缩压降低。与ASP组比较，APR组和AHR组30d主要终点的发生率无显著差异(MACE，调整OR 1.02，95%CI 0.47~2.17；严重出血，调整OR 1.92，95%CI 0.79~4.63)；AHR患者(MACE，调整OR 1.58，95%CI 0.71~5.51；严重出血，调整OR 0.69，95%CI 0.22~2.12)。APR包括量身定制的患者和AHR都与30天的不良疗效或安全性临床结果无关。
Aims The objective of the present substudy was to examine whether aspirin poor/high responsiveness (APR/AHR) is associated with increased rates of major adverse cardiovascular events (MACE) and serious bleeding after primary percutaneous coronary intervention (PPCI).Methods We analyzed 961 consecutive ST-elevation acute myocardial infarction patients who underwent PPCI between February 2008 and June 2011. Multiplate analyser (Dynabite, Munich, Germany) was used for the assessment of platelet reactivity. APR/AHR were defined as the upper/lower quintiles of ASPI values, determined 24 h after aspirin loading. APR patients were tailored using 300 mg maintenance dose for 30 days. The co-primary end points at 30 days were: MACE (death, non-fatal infarction, ischemia-driven target vessel revascularization and ischemic stroke) and serious bleeding according to the BARC classification.Results One hundred and 90 patients were classified as APR, and 193 patients as AHR. At admission, compared with aspirin sensitive patients (ASP), patients with APR had more frequently diabetes, anterior infarction and heart failure, while AHR patients had reduced values of creatine kinase, leukocytes, heart rate and systolic blood pressure. Compared with ASP, the rates of 30-day primary end points did not differ neither in APR group including tailored patients (MACE, adjusted OR 1.02, 95% CI 0.47-2.17; serious bleeding, adjusted OR 1.92, 95% CI 0.79-4.63), nor in patients with AHR (MACE, adjusted OR 1.58, 95% CI 0.71-5.51; serious bleeding, adjusted OR 0.69, 95% CI 0.22-2.12).Conclusions The majority of APR patients were suitable for tailoring. Neither APR including tailored patients nor AHR were associated with adverse 30-day efficacy or safety clinical outcomes.