Comparison of Platelet Function Tests in Predicting Clinical Outcome in Patients Undergoing Coronary Stent Implantation
Comparison of Platelet Function Tests in Predicting Clinical Outcome in Patients Undergoing Coronary Stent Implantation
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DOI：
10.1001/jama.2010.181
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发表时间：
2010-02-24
影响因子：
120.7
通讯作者：
ten Berg, Jurrien M.
中科院分区：
文献类型：
--
作者：
Breet, Nicoline J.;van Werkum, Jochem W.;ten Berg, Jurrien M.
背景高治疗血小板反应性与冠状动脉支架植入术后动脉粥样硬化血栓形成事件相关。目的评价多种血小板功能试验预测临床结局的能力。设计、设置和患者前瞻性、观察性、单中心队列研究，纳入2005年12月至2007年12月期间接受择期冠状动脉支架植入术的1069例连续服用氯吡格雷的患者。通过透光率聚集测定法、VerifyNow P2 Y12和Plateletworks测定法以及IMPACT-R和血小板功能分析系统（PFA-100）（使用Dade PFA胶原蛋白/二磷酸腺苷[ADP]测试卡片和Innovance PFA P2 Y）平行测量治疗中血小板反应性。通过受试者工作特征曲线分析（receiveroperatingcharacteristiccurve analysis.Main OutcomeMeasurement）确定治疗中高血小板反应性的临界值。主要终点定义为全因死亡、非致死性急性心肌梗死、支架内血栓形成和缺血性卒中的复合终点。主要安全性终点包括TIMI（心肌梗死溶栓）标准大出血和小出血。结果1年随访时，通过透光率聚集测定法评估，治疗中血小板反应性高的患者更容易出现主要终点（11.7%; 95%置信区间[CI]，8.9%-15.0%vs 6.0%; 95%CI，4.2%-8.2%; P
Context High on-treatment platelet reactivity is associated with atherothrombotic events following coronary stent implantation.Objective To evaluate the capability of multiple platelet function tests to predict clinical outcome.Design, Setting, and Patients Prospective, observational, single-center cohort study of 1069 consecutive patients taking clopidogrel undergoing elective coronary stent implantation between December 2005 and December 2007. On-treatment platelet reactivity was measured in parallel by light transmittance aggregometry, VerifyNow P2Y12 and Plateletworks assays, and the IMPACT-R and the platelet function analysis system (PFA-100) (with the Dade PFA collagen/adenosine diphosphate [ADP] cartridge and Innovance PFA P2Y). Cut-off values for high on-treatment platelet reactivity were established by receiver operating characteristic curve analysis.Main Outcome Measurement The primary end point was defined as a composite of all-cause death, nonfatal acute myocardial infarction, stent thrombosis, and ischemic stroke. The primary safety end point included TIMI (Thrombolysis In Myocardial Infarction) criteria major and minor bleeding.Results At 1-year follow-up, the primary end point occurred more frequently in patients with high on-treatment platelet reactivity when assessed by light transmittance aggregometry (11.7%; 95% confidence interval [CI], 8.9%-15.0% vs 6.0%; 95% CI, 4.2%-8.2%; P