Influential Factors And Prognostic Evaluation Of High On-Treatment Platelet Reactivity In Patients Undergoing Percutaneous Coronary Intervention

Objective To investigate the incidence and influential factors of high on-treatment platelet reactivity(HPR)in patients undergoing dual antiplatelet therapy after percutaneous coronary intervention(PCI).To evaluated prognostic impact of HPR for ischemic and long-term clinical outcomes.Methods There were 341 patients with coronary heart disease(CHD)receiving PCI in the second Department of Special Medical Treatment Center of Fuwai Hospital.All patients had been given enough dose of aspirin and clopidogrel.Thrombelastograph(TEG)was used to measure platelet reactivity.Defining ADP-induced maximal clot(MAADP)>47 mm and the platelet inhibition rate induced by adenosine diphosphate(ADP)<50%as HPR group,the rest patients were divided to normal platelet reactivity(NPR)group.The baseline data,range of coronary artery disease,number of stent,laboratory examination results were compared between HPR and NPR group.Logistic regression was applied to analyze the influential factors of HPR as well.Three-year follow-up was conducted to compare the difference in the incidence of major adverse cardiac events(MACE)between two groups in short-middle term and long term(1year,2year and 3year).Results The incidence of HPR in 341 patients after PCI was 25.8%.In univariate analysis of HPR,there were statistically significant differences in age,gender,smoking,D-Dimer,fibrinogen(Fbg)and high-sensitivity C-reactive protein(HsCRP)between HPR and NPR groups(P<0.05).A conditional logistic regression analysis showed that the age(OR=1.025,950%CI:1-1.05,P<0.05),female(OR=2.815,95%CI:1.339-5.916,P<0.05),Fbg(OR=1.808,95%CI:1.225-2.669,P<0.05)were independently influencing factors of HPR.There was statistical difference in the incidence of MACE events between the two groups in 1 year after PCI(P=0.041),but no significant difference in the incidence of MACE events in 2 or 3 years(P>0.05).Conclusion:The elderly,females and high level of Fbg were probably independent risk factors of HPR.HPR may be related to the incidence of MACE events in a year and was less effective in predicting long-term ischemic events after PCI.