Relationship between high platelet reactivity on clopidogrel and long-term clinical outcomes after drug-eluting stents implantation (PAINT-DES): a prospective, propensity score-matched cohort study.
Relationship between high platelet reactivity on clopidogrel and long-term clinical outcomes after drug-eluting stents implantation (PAINT-DES): a prospective, propensity score-matched cohort study.
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DOI：
10.1186/s12872-018-0841-1
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发表时间：
2018-05-24
影响因子：
2.1
通讯作者：
Zhang JJ
中科院分区：
文献类型：
--
作者：
Gao XF;Lu S;Ge Z;Zuo GF;Wang ZM;Wang F;Kong XQ;Chai DY;Chen SL;Zhang JJ
血小板反应性与长期临床结果之间的关系仍然存在争议。本前瞻性研究旨在探讨氯吡格雷高血小板反应性（HPR）与药物洗脱支架（DES）植入后长期临床结果之间的关系。2011年2月至2017年12月，共有1769例连续患者入组，采用Aggrestar （PL-11）评估。主要终点是主要心脑血管不良事件（MACCE），定义为明确或可能的支架血栓形成、自发性心肌梗死、全因死亡、临床驱动的靶血管重建术（TVR）或缺血性卒中。出血作为安全终点。采用倾向评分匹配（PSM）分析来调整整个队列的基线差异。409例（23.1%）患者经氯吡格雷治疗后出现HPR。中位随访4.1年（四分位数间距1.8年），氯吡格雷组HPR患者MACCE发生率明显高于氯吡格雷组正常血小板反应性（NPR） （15.6% vs. 5.4%, p < 0.001）。PSM后，395名配对患者匹配，氯吡格雷组HPR（15.7%）与NPR（9.4%）的MACCE差异仍然显著（P < 0.001），主要由HPR组全因死亡率增加（5.3%比1.8%,P < 0.001）和临床驱动的TVR（8.1%比6.3%,P = 0.019）驱动。两组之间的出血风险相似。这项前瞻性研究证实了氯吡格雷HPR与冠状动脉支架植入术后长期不良心血管事件之间的关系。本文的在线版本（10.1186/s12872-018-0841-1）包含补充材料，授权用户可以使用。
The relationship between platelet reactivity and long-term clinical outcomes remains controversial. The present prospective study was designed to explore the association between high platelet reactivity (HPR) on clopidogrel and long-term clinical outcomes following implantation of drug eluting stents (DES). A total of 1769 consecutive patients assessed by Aggrestar (PL-11) were enrolled at our center from February 2011 to December 2017. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCE), defined as definite or probable stent thrombosis, spontaneous myocardial infarction, all cause death, clinically driven target vessel revascularization (TVR), or ischemic stroke. Bleeding served as the safety endpoint. Propensity score matching (PSM) analysis was performed to adjust for baseline differences in the overall cohort. Finally, 409 patients (23.1%) were identified with HPR on clopidogrel. At a median follow-up of 4.1 years (interquartile range, 1.8 years), the occurrence of MACCE was significantly higher in HPR on clopidogrel group than normal platelet reactivity (NPR) on clopidogrel group (15.6% vs. 5.4%, p < 0.001). After PSM, 395 paired patients were matched, and the difference in MACCE between HPR (15.7%) versus NPR (9.4%) on clopidogrel groups remained significant (P < 0.001), mainly driven by increased all cause death (5.3% vs. 1.8%, p < 0.001), and clinically driven TVR (8.1% vs. 6.3%, p = 0.019) in the HPR group. The risk of bleeding between two groups was similar. This prospective study confirms the relationship between HPR on clopidogrel and long-term adverse cardiovascular events after coronary stenting. The online version of this article (10.1186/s12872-018-0841-1) contains supplementary material, which is available to authorized users.
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DOI：
10.1007/s11936-014-0300-y
发表时间：
2014-05-01
影响因子：
--
作者：
Franchi, Francesco;Rollini, Fabiana;Angiolillo, Dominick J
通讯作者：
Angiolillo, Dominick J
影响因子：
37.8
作者：
Price, Matthew J.;Angiolillo, Dominick J.;Topol, Eric J.
通讯作者：
Topol, Eric J.
影响因子：
2.7
作者：
Kim, Moo Hyun;Choi, Sun Young;Serebruany, Victor
通讯作者：
Serebruany, Victor
耐药性和伪耐药性：肠涂层阿司匹林的意外结果。
影响因子：
37.8
作者：
Grosser T;Fries S;Lawson JA;Kapoor SC;Grant GR;FitzGerald GA
通讯作者：
FitzGerald GA
影响因子：
168.9
作者：
Sibbing, Dirk;Aradi, Daniel;Investigators, TROPICAL-ACS
通讯作者：
Investigators, TROPICAL-ACS