| Objectives This study sought to evaluate the predictive value of HPR on clinical outcomes for patients undergoing PCI with different clinical characteristics, such as calcified stenosis and Diabetes Mellitus (DM).Methods1.263 ACS patients (60.4±11.6 years old) undergoing PCI were continuously recruited from October 2013 to October 2014 in Chinese PLA General hospital. All patients were divided into diabetic group (61 patients) and non-diabetic group (202patients), all with an administration of dual antiplatelet therapy. AA and ADP-induced platelet reactivity index were detected though Thrombelastogram.Clinical data of patients, such as age, gender and other characteristics were colleced. ADP-induced High Platelet Reactivity(HPR) was defined as the platelet reactivity index≥ 50%. All patients were followed up for 9 months after PCI.2.263 ACS patients (60.4±11.6 years old) undergoing PCI were continuously recruited from October 2013 to October 2014 in Chinese PLA General hospital. According to the results of coronary artery angioplasty, all patients were divided into calcified group (113 patients) and non-calcified group (150 patients), all with an administration of dual antiplatelet therapy. The follow-up methods and definition of HPR were the same as those in the first part.3.113 calcified patients of 263 ACS patients (57.6±11.6 years old) were recruited. All patients were divided into diabetic group (27 patients) and non-diabetic group (86 patients). The follow-up methods and definition of HPR were the same as those in the first part.Results 1. The proportion of HPR in diabetic group was higher than that in non-diabetes patients 27.9% vs 16.3%(P=0.044). In diabetic group, the incidence of MACE after PCI in patients with HPR was higher than that in patients without HPR,35.3%vs6.8% (P=0.016). In non-diabetic group, the incidence of MACE after PCI in patients with HPR and without HPR was 12.1%vs5.9%(P=0.363). In diabetic group,the logistic regression coefficient between HPR with MACE after PCI was 2.387, (P=0.017). In non-diabetic group, the logistic regression coefficient between HPR with MACE after PCI was 0.763,(P =0.247).In overall group, the interactions between DM with HPR on MACE after PCI had statistical significance, P=0.019. In unstable angina subgroup, interactions between DM with HPR on MACE after PCI did not have statistical significance,P=0.374.In non-ST elevation myocardial infarction subgroup, interactions between DM with HPR on MACE after PCI did not have statistical significance, P=0.550. In ST elevation myocardial infarction subgroup, interactions between DM with HPR on MACE after PCI had statistical significance, P=0.000.2. The proportion of HPR was higher in calcified group than that in non-calcified group (P=0.007). In calcified group, the incidence of MACE after PCI in patients with HPR was higher than that in patients without HPR 33.3%vs4.8%(P=0.000). In non-calcified group, the incidence of MACE after PCI in patients with HPR and without HPR 10.0%vs5.4%(P=0.343).In calcified group, the logistic regression coefficient of HPR with MACE after PCI was 1.54,(P=0.009). In non-calcified group, the logistic regression coefficient between HPR with MACE after PCI was 0.669,(P=0.426).In overall group, the interactions between calcification with HPR on MACE after PCI did not have statistical significance, P=0.097. In unstable angina subgroup, interactions between calcification with HPR on MACE after PCI did not have statistical significance, P=0.572. In non-ST elevation myocardial infarction subgroup, interactions between calcification with HPR on MACE after PCI did not have statistical significance, P=0.114. In ST elevation myocardial infarction subgroup, interactions between calcification with HPR on MACE after PCI did not have statistical significance, P=0.143.3. In ACS patients accompanied with culprit coronary artery calcification, the ADP-induced PRI was higher in DM group than that in non-DM group (36.9±30.2)% vs (30.1±27.8)%, P=0.048. The interactions between DM with HPR on MACE after PCI had statistical significance, P=0.024.Conclusion1 The predictive value of HPR on MACE after PCI was stronger in diabetic group than that in non-diabetic group. The higher incidences of MACE in diabetic group after PCI may be influenced by the higher proportion of HPR in patients with diabetes.2. The predictive value of HPR on MACE after PCI was stronger in calcified group than that in non-calcified group.The impact of higher incidences of MACE in calcified group after PCI by higher proportion of HPR in calcified group was not obvious.3. In ACS patients accompanied with calcification, the higher incidence of MACE in diabetic group after PCI may be influenced by the higher ADP-induced PRI in patients with diabetes. |
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