The Phenomenon Of Clopidogrel Resistance And Its Risk Factors Logistic Regression Analysis

Objective:To observe the phenomenon of clopidogrel resistance in coronary heart disease suffers undergoing percutaneous coronary intervention. And logistic regression analysis of its major factors may affect this phenomenon, in order to take appropriate preventive measures to provide evidence.Methods:The study population included 100 patients admitted to the Department of Cardiology in the First Affiliated Hospital of Kunming Medical College from January 2009 to September 2009. All patients received a 300-mg loading dose of clopidogrel (trade name:Plavix).The ADP-induced MPAR were measured by light transmittance aggregometry at baseline and at 12 hours and 5 days.PAC-1 and CD62P were assessed by whole-blood flow cytometry at the same time points. Patients having> 10% inhibition of platelet aggregation were defined as normal responders, whereas those having≤10% inhibition were clopidogrel resistance patients. Platelet function was compared in patients. The recurrence of the MACE were also compared at 30-day and 6-month follow-up after percutaneous coronary intervention. And logistic regression analysis of major factors of this phenomenon.Results:The ADP-induced MPAR were similar in all patients at baseline (P> 0.05). Baseline CD62P was higher in clopidogrel resistance patients (25.55±9.10% vs 16.58±6.20%, P<0.001). Although CD62P reduced following clopidogrel front-loading in both groups, it remained higher among clopidogrel resistance patients(6.44±1.45% vs 4.38±1.07%, P=0.011) in 12 hours after receiving clopidogrel front-loading and it also higher among these individuals (3.21±0.84% vs 2.23±0.34%, P=0.009) in 5 days after clopidogrel administration. Baseline PAC-1 was higher in clopidogrel resistance patients (14.44±3.53% vs 7.90±1.10%, P=0.034).Although PAC-1 reduced following clopidogrel front-loading in both groups, it remained higher among clopidogrel resistance patients(12.32±1.45% vs 7.36±1.44%, P=0.04) in 12hours after receiving clopidogrel front-loading and it also higher among these individuals (5.06±0.83% vs 4.09±0.98%, P=0.035) in 5 days after clopidogrel administration. Patients were followed for 30 days and 6 months after percutaneous coronary intervention, the clopidogrel resistance patients were increased risk for ischemic events(50.00% vs 13.16%, P<0.001; 65.21% vs 22.22%, P=0.033). The further independent-sample T test (or x2 test)also proved the impact of BMI, hypertension, IR, and kinds of CHD except obesity on the response to clopidogrel (P<0.05). Logistic regression analysis results 3 risk factors for clopidogrel resistance: BMI, IR and coronary heart disease category have a strong positive correlation with the phenomenon of clopidogrel resistance (OR, respectively 1.233,1.783 and 3.028, P<0.05).Conclusions:A considerable proportion patients have a clopidogrel resistance to a 300mg clopidogrel loading dose. Increased PAC-1 and CD62P before clopidogrel front-loading may identify this group of patients.We found a statistically significant relation between the degree of clopidogrel resistance in different types of coronary heart disease sufferers undergoing percutaneous coronary intervention and the recurrence of the MACE. According to the results of the analysis on risk factor for clopidogrel resistance.we should make some effective measures against clopidogrel resistance in the high-risk population.