Persistent high on-treatment platelet reactivity in acute coronary syndrome.
Persistent high on-treatment platelet reactivity in acute coronary syndrome.
复制标题
急性冠脉综合征治疗中血小板持续高反应性。
DOI：
10.1007/s11239-012-0678-x
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发表时间：
2012
影响因子：
4
通讯作者：
Williams,MarleneS
中科院分区：
文献类型：
--
作者：
LynchJr,DonaldR;Khan,FarooqH;Vaidya,Dhananjay;Williams,MarleneS
在接受适当抗血小板治疗的急性冠状动脉综合征（ACS）患者中，持续的高治疗血小板反应性与心血管事件风险增加相关;然而，这种现象随时间的演变尚不清楚。我们调查了首次出现ACS后3个月随访时的血小板活性。本研究共纳入124例患者，其中65例被诊断为ACS，59例为非心源性胸痛的对照组患者进行基线比较。在入组的患者中，我们有25名ACS患者在首次就诊后3个月病情稳定返回进行重复血小板功能检测。在基线时监测肾上腺素（EPI）、二磷酸腺苷（ADP）和花生四烯酸诱导的血小板聚集，并在随访时重复测量EPI和ADP刺激的血小板聚集。此外，在就诊时和3个月随访期监测P-选择素和PAC-1表达。ACS患者在干预期间维持阿司匹林治疗。在三个月的随访中，开始服用阿司匹林的ACS患者的EPI和ADP的次最大浓度的聚集百分比没有显著变化。PAC-1或P-选择素表达也没有显著的百分比变化。这项研究表明，ACS患者在3个月随访时持续存在高治疗血小板反应性，这可能使这些患者的心血管事件复发风险增加。
Persistent high on-treatment platelet reactivity in acute coronary syndrome (ACS) patients managed with appropriate antiplatelet therapy has been correlated with increased risk of cardiovascular events; however, the evolution of this phenomenon overtime is not well known. We investigated platelet activity at a three month follow-up after initial presentation with an ACS. We enrolled a total of 124 patients in the study, 65 were diagnosed with ACS and 59 controls who presented with non-cardiac chest pain for baseline comparisons. Of the enrolled patients, we had 25 ACS patients return, in stable condition, three months after their initial presentation for repeat platelet functional testing. Epinephrine (EPI), adenosine diphosphate (ADP), and arachidonic acid induced platelet aggregation were monitored at baseline with repeat measurement of EPI- and ADP-stimulated aggregation at follow-up. In addition, P-selectin and PAC-1 expression were monitored at presentation and at a three month follow-up period. ACS patients were maintained on aspirin therapy during the intervening period. At the three month follow-up visit, ACS patients initiated on aspirin had no significant percentage change in aggregation to submaximal concentrations of EPI and ADP. They also had no significant percentage change in PAC-1 or P-selectin expression. This study demonstrates persistent high on-treatment platelet reactivity in ACS patients at a three month follow-up, which may place these patients at increased risk of recurrent cardiovascular events.