Risk Stratification After Coronary Artery Bypass Surgery by a Point-of-Care Test of Platelet Function
Risk Stratification After Coronary Artery Bypass Surgery by a Point-of-Care Test of Platelet Function
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DOI：
10.1016/j.athoracsur.2008.05.038
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发表时间：
2009-02-01
影响因子：
4.6
通讯作者：
Gianetti, Jacopo
中科院分区：
文献类型：
--
作者：
Bevilacqua, Stefano;Alkodami, Al Assal;Gianetti, Jacopo
背景。阿司匹林因其抗血小板活性而成为预防心血管事件的主要治疗药物之一。然而，阿司匹林并不总是能够充分抑制血小板功能。这意味着对心血管事件的保护程度是有限的。最近，一些研究引入了阿司匹林治疗期间残余血小板反应性的概念，并表明约 40% 的阿司匹林使用者可能没有充分反应。我们试图确定用血小板功能分析仪（PFA-100；Dade/Behring，马尔堡，德国）设备测量的残余血小板反应性的概况和发生率是否可以预测接受冠状动脉搭桥手术的患者的复发性心血管事件。方法。前瞻性招募了 202 名 2004 年期间接受初次冠状动脉搭桥手术的连续患者。所有患者术后均每日常规服用100 mg阿司匹林。术后 30 +/- 6 天通过 PFA-100 分析血小板功能。 PFA100 闭合时间小于 190 秒被定义为残余血小板反应性。 86 名患者 (43%) 表现出残留的血小板反应性。平均随访时间为 32 +/- 10 个月，完成率 100%。结果。总共登记了 75 起心血管事件。这些事件大多数发生在具有残余血小板活性的患者中（p = 0.001）。其中 25 名患者出现移植失败。对于充分抑制血小板的患者，42 个月内没有发生重大心血管事件的情况明显更好 (p = 0.001)。在多变量分析中，残余血小板反应性（p = 0.012）、不完全血运重建（p = 0.029）和糖尿病（p = 0.0009）与不良事件的发生独立相关。结论。我们的结果表明，高残留血小板反应性与接受冠状动脉搭桥手术的患者最差的临床结果独立相关。 PFA-100 点护理测试可以廉价且简单地发现这种情况，并有助于改善这部分患者的治疗结果。
Background. Aspirin is one of the main therapeutics in prevention of cardiovascular events due to its antiplatelet activity. However, a sufficient inhibition of platelet function by aspirin is not always achieved. This means that the extent of protection from cardiovascular event is limited. Recently, several studies have introduced the concept of residual platelet reactivity during aspirin therapy and suggested that about 40% of aspirin users may not respond adequately. We sought to determine whether the profile and prevalence of residual platelet reactivity, measured with the platelet function analyzer (PFA-100; Dade/Behring, Marburg, Germany) device could predict a recurrent cardiovascular event in patients undergoing coronary artery bypass surgery.Methods. A cohort of 202 consecutive patients receiving primary coronary artery bypass surgery during 2004 was prospectively recruited. All patients postoperatively received regular standard daily 100 mg aspirin. Platelet function was analyzed by the PFA-100 at 30 +/- 6 days after surgery. A PFA100 closure time less than 190 seconds was defined as residual platelet reactivity. Eighty-six patients (43%) showed residual platelet reactivity. The mean follow-up time was 32 +/- 10 months and was 100% complete.Results. A total of 75 cardiovascular events have been registered. The majority of these events were among patients with residual platelet activity (p = 0.001). Out of this number, graft failure was documented in 25 patients. The 42-month freedom from major cardiovascular events was significantly better for patients with adequate platelet inhibition (p = 0.001). At multivariable analysis residual platelet reactivity (p = 0.012), incomplete revascularization (p = 0.029), and diabetes (p = 0.0009) were independently associated with occurrence of negative events.Conclusions. Our results demonstrate that high residual platelet reactivity independently correlates with a worst clinical outcome in patients treated by coronary artery bypass surgery. The PFA-100 point care test could cheaply and simply discover this condition and contribute to improve the outcome of this subset of patients.