Changes Of Platelet Function In Coronary Heart Disease Patients With DAPT

?Background and Objective?In China,the standardized mortality rate of coronary heart disease,especially myocardial infarction,shows a significant upward trend.In the pathophysiology of coronary heart disease,increased platelet aggregation plays a key role in thrombosis.Dual antiplatelet therapy?DAPT?has become routine practise for antithrombotic therapy in patients with acute coronary syndrome?ACS?and percutaneous coronary intervention?PCI?.some patients still have cardiovascular events during DAPT.This lack of efficacy is partly due to the reduced response of patients to aspirin and/or clopidogrel,resulting in high on-treatment platelet reactivity?HPR?and atherothrombotic complications.In this study we made use platelet function analyzer?PL-12?to detect the platelet aggregation function?AA+ADP?in coronary heart disease patients with DAPT,observed the changes of platelet aggregation before and during DAPT in patients with coronary heart disease,and analysed the influencing factors of HPR and major adverse cardiovascular events?MACE?within 6 months after PCI,such as gender,age,hypertension,diabetes,smoking history,the type of coronary heart disease,the number of vascular lesion,the number of stent implantation,blood glucose,renal function,blood lipid,HbA1c,blood platelet,mean platelet volume.So we can provide reference for the diagnosis and treatments of clinicians and improvement of patient's prognosis.?Methods?408 patients with DAPT were admitted to the observation in The First Affiliated Hospital of Dalian Medical University from Oct.2015 to Jul.2017.The patients were diagnosed as coronary heart disease by coronary angiography and were successfully treated with PCI.We made use platelet function analyzer?PL-12?to determine platelet aggregation function?AA+ADP?before DAPT and at 1 month and 3month of DAPT.The results were based on the maximum platelet aggregation rate?MAR?.MAR_AA?60%for aspirin HPR,and MAR_ADP?55%for clopidogrel HPR.We collected the data and MACE occurred within 6 months after PCI through outpatient review or telephone follow-up.To observe the changes of MAR before DAPT and at 1month and 3 month of DAPT,and to analyze the influencing factors of HPR and MACE.?Results?1.The mean MAR_AA before DAPT was 67.55%,the mean MAR_AAA was 32.65%at1month of DAPT,and aspirin HPR was 11?2.70%?in 408 patients.The mean MAR_AAA was 33.04%at 3 month of DAPT and 9?2.21%?patients were aspirin HPR.2.The mean MAR_ADP before DAPT was 66.06%,the mean MAR_ADP was 47.58%at 1month of DAPT,and clopidogrel HPR was 124?30.39%?in 408 patients.The mean MAR_ADP was 49.36%at 3month of DAPT and 141?34.56%?patients were Clopidogrel HPR.3.Chi-square test and logistic regression analysis showed that the influencing factors of HPR were:gender(OR:2.577,95%[CI]:0.245-0.614,p<0.001,diabetes?OR:1.874,95%[CI]:1.208-2.907,p=0.005?.4.Chi-square test and logistic regression analysis showed that the influencing factors of MACE within 6 months after PCI were:HbA1c?OR:2.014,95%[CI]:1.055-3.845,p=0.035?,clopidogrel HPR?OR:2.923,95%[CI]:1.522-5.614,p<0.001?,gender?OR:2.273,95%[CI]:0.066-0.293,p<0.001?.?Conclusions?1.Dual antiplatelet therapy significantly improve platelet aggregation in the early stages of treatment.2.Gender and diabetes have a significant effect on clopidogrel HPR.3.Age,hypertension,smoking history,the type of coronary heart disease,the number of vascular lesion,the number of stent implantation,blood glucose,renal function,blood lipid,HbA1c,blood platelet,mean platelet volume have no significant effect on clopidogrel HPR.4.HbA1c,clopidogrel HPR,gender is the influencing factor of MACE within 6 months after PCI.