Impacts Of Renal Function And Fibrinogen On Platelet Reactivity And Outcomes Of ACS Patients Receiving Clopidogrel And Undergoing PCI

Objective: This study aimed to assess renal function, fibrinogen levels and platelet reactivity of ACS patients undergoing PCI, and analyze the effects of renal function and fibrinogen to platelet function, besides, investigate the influence factors of 1-year major adverse cardiac event. Method: Recruited 1425 ACS patients undergoing PCI in our hospital continuously, subsequently detected ADP-induced platelet aggregation ratio by turbidimetry after standard double antiplatelet therapy, >40% was defined as high platelet reactivity. Collected influence factors related to coronary heart disease. Divided patients into 2 groups with or without moderate to severe CKD in accordance with GFR< or ≥60 ml/min, meanwhile patients were split into high fibrinogen levels(>4g/L), normal fibrinogen levels(2-4g/L), and low fibrinogen levels(<2g/L) 3 groups. In addition, followed up all subjects. Finally analyzed the relationship between CKD, fibrinogen levels and platelet reactivity, and determined predictors of MACE by univariate analysis and Cox regression. Results: We failed finding the relationship between moderate to severe CKD and HPR, however subgroup analysis showed patients with moderate to severe CKD and diabetes had significantly increased prevalence of HPR(p=0.018), high fibrinogen levels were associated with incidence of HPR(p<0.001), moderate to severe CKD patients with diabetes(OR: 2.358, 95% CI: 1.470~3.783), HPR(OR: 4.382, 95% CI: 2.219~8.651) were independent predictors of 1-year MACE(p<0.05). Conclusion: Impact of CKD on platelet reactivity might be due to diabetes, and fibrinogen levels could affect the antiplatelet effects of clopidogrel, as well moderate to severe CKD with diabetes and HPR influenced prognosis after 1 year undergoing PCI.