Impact of platelet reactivity after clopidogrel administration on drug-eluting stent thrombosis
Impact of platelet reactivity after clopidogrel administration on drug-eluting stent thrombosis
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DOI：
10.1016/j.jacc.2007.01.094
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发表时间：
2007-06-19
影响因子：
24
通讯作者：
Antoniucci, David
中科院分区：
文献类型：
--
作者：
Buonamici, Piergiovanni;Marcucci, Rossella;Antoniucci, David
目的我们试图确定体外治疗后血小板高反应性所揭示的对氯吡格雷无反应是否可以预测药物洗脱支架 (DES) 血栓形成。背景尚无关于氯吡格雷无反应对 DES 血栓形成风险影响的数据。方法我们于 2005 年 7 月至 2006 年 8 月在一家学术医院进行了一项前瞻性观察性队列研究。共有 804 名成功植入西罗莫司或紫杉醇洗脱支架的患者在接受 600 mg 氯吡格雷负荷剂量后评估了治疗后血小板反应性。 10μmol腺苷5'-二磷酸导致血小板聚集≥70%的患者被定义为无反应者。所有患者均接受长期双重抗血小板治疗（每日阿司匹林 325 mg 和氯吡格雷 75 mg），为期 6 个月。主要终点是6个月随访时明确/可能早期、亚急性和晚期支架内血栓的发生率。结果6个月明确/可能支架血栓的发生率为3.1%。所有支架内血栓均为亚急性或晚期。在 804 名患者中，105 名（13%）对氯吡格雷没有反应。无反应者中支架血栓的发生率为 8.6%，有反应者中为 2.3%（p < 0.001）。通过多变量分析，支架血栓形成的预测因素如下：对氯吡格雷无反应（风险比 [HR] 3.08，95% 置信区间 [Cl] 1.32 至 7.16；p = 0.009）、左心室射血分数（HR 0.95，95% Cl 0.92 至 0.98；p = 0.001）、支架总长度（HR 1.01，95% Cl 1.00 至 1.02； p = 0.010）和 ST 段抬高急性心肌梗死（HR 2.41，95% Cl 1.04 至 5.63；p = 0.041）。 结论 对于接受西罗莫司或紫杉醇洗脱支架的患者，对氯吡格雷无反应是支架血栓形成的强有力的独立预测因子。
ObjectivesWe sought to determine whether non responsiveness to clopidogrel as revealed by high in vitro post-treatment platelet reactivity is predictive of drug-eluting stent (DES) thrombosis.BackgroundNo data exist about the impact of non responsiveness to clopidogrel on the risk of DES thrombosis.MethodsWe conducted a prospective observational cohort study from July 2005 to August 2006 in an academic hospital. A total of 804 patients who had successful sirolimus- or paclitaxel-eluting stent implantation were assessed for post-treatment platelet reactivity after a loading dose of 600 mg of clopidogrel. Patients with platelet aggregation by 10 mu mol adenosine 5'-diphosphate >= 70% were defined as nonresponders. All patients received chronic dual antiplatelet treatment (aspirin 325 mg and clopidogrel 75 mg daily) for 6 months. The primary end point was the incidence of definite/probable early, subacute, and late stent thrombosis at 6-month follow-up.ResultsThe incidence of 6-month definite/probable stent thrombosis was 3.1%. All stent thromboses were subacute or late. Of 804 patients, 105 (13%) were not responsive to clopidogrel. The incidence of stent thrombosis was 8.6% in nonresponders and 2.3% in responders (p < 0.001). By multivariate analysis, the predictors of stent thrombosis were as follows: non responsiveness to clopidogrel (hazard ratio [HR] 3.08, 95% confidence interval [Cl] 1.32 to 7.16; p = 0.009), left ventricular ejection fraction (HR 0.95, 95% Cl 0.92 to 0.98; p = 0.001), total stent length (HR 1.01, 95% Cl 1.00 to 1.02; p = 0.010), and ST-segment elevation acute myocardial infarction (HR 2.41, 95% Cl 1.04 to 5.63; p = 0.041).ConclusionsNon responsiveness, to clopidogrel is a strong independent predictor of stent thrombosis in patients receiving sirolimus- or paclitaxel-eluting stents.