Clinical Features Of Clopidogrel Resistance In Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Objective:To observe clinical features of patients with coronary heart diseasethrough DAPT after PCI,and analyzing risk factors whose may be influence clopidogrel resistance.Methods:1.50 patients withcoronaryheart disease after PCI,hospitalization in The Affiliated Hospital ofthe Armed Police College,chosen from May 2014 to October2014, routine oraling aspirin 300 mg once and clopidogrel 300 mgonce before PCI,blood sample was collected after 24 hours of GP Ⅱ b/ Ⅲareceptorantagonist(e.g Tirofiban Hydrochloride 、 bivalirudin)Complete metabolism.TEG and PL-11 were used to detect platelet aggregation.Comparison of two kinds of instrument detection efficiency and Compare the effect of clopidogrel and aspirin.2. 150 patients withcoronaryheart disease after PCI,hospitalization in The Affiliated Hospital ofthe Armed Police College,chosen from June 2014 to February 2016, routine oraling aspirin 300 mg once and clopidogrel 300 mgonce before PCI,blood sample was collected after 24 hours of GPⅡb/Ⅲ areceptorantagonist(e.g Tirofiban Hydrochloride 、 bivalirudin)Complete metabolism.an was examined with thromboelastography(TEG), Platelet function was adenosine diphosphate(ADP) induced platelet aggregation inhibition rate,the result<30% is clopidogrel resistance.patients were divided into clopidogrel resistance group and no clopidogrel resistance group.Collect linical data and survery reportsto make statistical analysis.Results:1 Comparison of thromboelastography and PL-11The ADP induced platelet aggregation rate was positively correlated withthe PL-11 method and the TEG method.(r = 0.781, P > 0.05).The regression equation is Y(thromboelastography)=1.033X-2.813,R2=0.609,Moderate correlation.The AA induced platelet aggregation rate was positively correlated withthe PL-11 method and the TEG method. The regression equation is(r=0.882,P>0.05),The regression equation is Y(thromboelastography)=1.0207 X-9.154,R2=0.778,Highly correlated.2 Compare the effects of aspirin and clopidogrelSample t test display,PL-11, TEG were detected in the ADP induced platelet aggregation rate and the AA induced platelet aggregation rate.The results were statistically significant(P<0.001).The results of the two methods show that the rate of platelet aggregation induced by AA was better than that of ADP.3Incidence of clopidogrel resistance.Inclusion criteria and exclusion criteria based on clinical analysis,A total of 150 patients were enrolled.According to the definition of clopidogrel resistance(CR),Clopidogrel resistance group(CR group) 37 cases(24.67%),Non clopidogrel resistance group(NCR group)113 cases(75.33%),The incidence of clopidogrel resistance was 24.67%.4Clinical data comparisonCR group and NCR group general clinical data comparison results show that in Age(P=0.965),Smoking(P=0.653), hypertension(P=0.671),Hyperlipoidemia(P=0.85),There was no significant statistical significance(P > 0.05).In Sex ratio(P=0.007),Diabetes Mellitus(P=0.02),There wassignificant statistical significance(P<0.05).5Biochemical parameterscomparisonComparison of biochemical parameters between CR group and NCR group,Two groups of patients were compared in platelet count, white blood cell, triglyceride, total cholesterol, Low density lipoprotein, glycosylated hemoglobin, fasting blood glucosewere not statistically significant differences(P>0.05).6Comparison of clinical drug useCR group and NCR group comparison of clinical drug use.Two groups of patients in the use of statins,Isosorbide Mononitrate,ACEI/ARB, β-blockerwere not statistically significant difference(P>0.05).7Comparison of Coronary angiography imaging resultsComparison of coronary artery imaging results in CR group and NCR group. Two groups of patients in Degree of coronary artery disease(single vessel disease,multivessel disease)(P=0.001) were statistically significant difference(P<0.05).8Logistic regression analysisUsing Logistic regression to analyze the related influencing factors,Including gender, diabetes mellitus,Multi vessel coronary artery disease, hypertension, Smoking, Hyperlipoidemia, ACEI/ARB,β- blockerfor multiple factors regression analysis. There were significant statistical differences in Sexuality(P=0.061,OR=2.245、95%CI=0.964-5.227)、DM(P=0.037,OR=2.439、95%CI=1.005-5.637)、Degree of coronary artery lesion(P=0.025,OR=2.889、95%CI=1.140-7.318).Conclusion:1 thromboelastographycontrast PL-11 with Detection of platelet function,have good consistency.2 Patients with coronary heart disease after PCI,Aspirin is superior to clopidogrel in inhibiting platelet function3 Patients with coronary heart disease after PCI,exactly has clopidogrel resistance.And through DAPT also has Higher incidence of Clopidogrel resistance.4Sexuality,DM,Degree of coronary artery lesion may be risks factors the appearance of clopidogrel resistance.5 In this clinicalanalysis, age,smoking history,hypertensionhyperlipemia Taking the statins,platelet count indicates there isn’t significant statistical difference.