Clinical Significance Of Reconstructing Thrombelastogram Monitoring Undergoing Percutaneous Coronary Reascularization

Objectives Research the clinical significance of reconstructing Thrombelastogram monitoring undergo-ing percutaneous coronary reascularization.Methods 200 patients cases of coronary heart disease were continuously selected from Aug 2013 to Jan 2015 in the department of cardiology in Meitan General Hospital. Record all the basic clinical datum of the patients: including age, gender, weight, smoking history, hypertension history, hyperlipidemia history, diabetes history, coronary heart disease(unstable angina, acute ST-segment elevation myocardial infarction, non-ST segment elevation acute myocardial infarction), coronary angiography or coronary CTA results, biochemical parameters, left ventricular ejection fraction. The rate of diphosphate(ADP) and arachidonic acid(AA) platelet inhibition aggregation were measured by thrombelastography for all the patients.more than 60% of ADP induced platelet inhibition rate was defined as group has good inhibition rate. <40% of which was the falls below group. 40% ~ 60% was the effective group. 1 To analyze the distribution proportion of the patients among the three groups. 2 To analyze the differences among the three groups for age, male, weight, history of hypertension, history of hyperlipidemia, history of diabetes. 3 Analysis the distribution proportion among the three groups about combining with hypertension and diabetes. 4 To analyze the extent of the three groups of patients with CHD(UAP, STEMI, NSTEMI, and interventional treatment) situation. 5 The genetic polymorphism of CYP2C19 was detected in 41 patients. A according to the result of genetic testing, all patients were divided into extensive metabolism(EM, CYP2C19*1/*1)group, intermediate metabolism(IM, CYP2C19*1/*2、*1/*3)group and poor metabolism(PM, CYP2C19*2/*2、*2/*3、*3/*3)group. To analyze the rate of ADP-induced platelet inhibition in different genetic group. 6 In-stent restenosis occurred in 25 patients after coronary sent implantation. Analysis in-stent restenosis after coronary sent implantation in the different rate of ADP-induced platelet inhibition. 7 To analyze the rate of ADP-induced platelet inhibition in different results of coronary angiography. 8 To analyze the rate of diphosphate(ADP) or arachidonic acid(AA) platelet inhibition after different treatment strategies. 9 To analyze the clopidogrel resistance and aspirin resistancein patients with general clinical data. The results were analyzed by SPASS19.0 software.Results 1 The cases number of the three groups are respectively 99 cases(49.5%), 44 cases(22%), 57 cases(28.5%). 2 There have no statistical difference in age, male, history of hypertension, hyperlipidemia, diabetes history among the three groups. 3 The rates of patients of patients with hypertension were: 66.7%, 63.6%, 68.9%. 4 The rates of patients with diabetes were: 41.4%, 50.0%, 45.6%. 5 The rates of patients with concomitant diabetes rates are: 33.3%, 40.9%, 36.8%. 6 There were not statistical difference in the three groups(unstable angina, non-ST segment elevation myocardial infarction, STsegment elevation myocardial infarction and undergoing PCI treatment). 7 The different rate of ADP-induced platelet inhibition between intermediate metabolism group and poor metabolism group, between extensive metabolism group and poor metabolism group have statistically significant(P<0.05). There were not statistical differences between extensive metabolism group and intermediate metabolism group. 8 the rate of ADPinduced platelet inhibition in different genetic group have statistically significant(P<0.05). 9 The rate of ADP-induced platelet inhibition in different results of coronary angiography has not statistical differences. 10 The rate of platelet inhibition after different treatment strategies has statistically significant(P<0.05). 11 The clopidogrel resistance and aspirin resistancein patients with general clinical data has no statistical differences.Conclusion 1 All the patients took clopidogrel regularly. The rate of ADP-induced platelet inhibition in in-stent restenosis patients was significantly lower than the patients who were no in-stent restenosis. 2 Some clopidogrel resistance patients after they change the anti-platelet agent, the rate of ADP-induced platelet inhibition was significantly higher. 3 Patients with different genetic group, the rate of ADP-induced platelet inhibition of poor metabolism group was obviously higher than the the other groups.4 The percent of clopidogrel resistance was 28.5%, the percent of aspirin resistance was 19.5%, the percent both of clopidogrel and aspirin resistance was 8.5%.