| Objective: Cerebral infarction has the characteristics of high incidence and high recurrence rate.Some patients taking aspirin regularly still can not prevent the recurrence of cerebral infarction,that is,aspirin resistance.The recurrence of cerebral infarction will further aggravate the burden on patients.It is particularly important to identify this part of the patient early and it is necessary to confirm the correlation between aspirin resistance confirmed by certain detection methods and clinical cerebral infarction recurrence and whether it can make predictions still needs more evidence to prove.This study was designed to investigate the predictive value of aspirin resistance in the recurrence of atherosclerotic cerebral infarction and the correlation between the two.Methods: A total of 393 patients with atherosclerotic cerebral infarction admitted to the Department of Neurology,Affiliated Hospital of Qingdao University from January2015 to June 2017 were included.All patients were treated with aspirin(100 mg/d ≥ 7days).Whole blood samples were collected for thromboelastography(TEG)and the results were expressed as AA inhibition rate.AA inhibition rate <50% was defined as aspirin resistance,AA inhibition rate≥50% was considered as sensitive to aspirin.Collecting clinical data of these patients.We followed-up for at least 1 year and recorded recurrent episodes of cerebral infarction and other vascular events.Patients were divided into aspirin resistance group(AR group)and aspirin sensitive group(AS group)according to AA inhibition rate.U-test and χ2 test analysis were used to compare clinical baseline data between the two groups.According to the follow-up results,patients with cerebral infarction were divided into recurrent group and non-recurring group.Logistic regression model was used for univariable and multivariable analysis.Spearman correlation was further used to analyze the association between aspirin resistance and recurrent cerebral infarction.The predictive value of AR for cerebral infarction recurrence events was assessed by receiver operating characteristic curve(ROC).The K-M method was used to evaluate the cumulative survival analysis and cumulative risk of recurrent cerebral infarction in the AR group and the AS group.Results: A total of 393 patients with cerebral infarction were included in the study.The median follow-up time was 30 months(IQR: 25-34 months).The median age of the patients was 65 years old(IQR: 58-73 years old),males accounted for 66.9%;101 patients(25.7%)showed AR,292 patients.(74.3%)behaved as AS.Males accounted for 55.4% of AR patients.The recurrence rate of cerebral infarction in the AR group was 35.6%,which was higher than the recurrence rate of 21.6% in the AS group.Univariable analysis showed that cerebral infarction,NIHSS score,mRS score,AR and medication compliance were the factors affecting the recurrence of cerebral infarction(P<0.05).Multivariate analysis showed that the history of cerebral infarction and AR were risk factors for recurrent cerebral infarction(P<0.05),and medication compliance was a protective factor for recurrent cerebral infarction(P<0.001).The risk of recurrent events in patients with a history of cerebral infarction was 2.251 times(95% CI: 1.336-3.793;P=0.002)higher than that of patients with initial cerebral infarction.Patients with AR had a 1.737 times(95%CI: 1.008-2.990;P=0.047<0.05)higher risk of stroke recurrence than that of patients with AS.The adherence to medication could reduce the risk of recurrence by 0.214 times(95%CI: 0.128-0.357;P<0.001).Spearman correlation showed a significant correlation between AR and recurrent cerebral infarction with a correlation coefficient of 0.142(P =0.005).The c-statistic of AR prediction of recurrent cerebral infarction with ROC curve evaluation was 0.571(95% CI: 0.504-0.638;P=0.034<0.05).The sensitivity was 35.6%and the specificity was 78.4%.The cumulative survival analysis and cumulative risk test for cerebral infarction recurrence in the two groups were 6.784,and there was a statistical difference between the two(P = 0.009 <0.05).Conclusions: Aspirin resistance is not uncommon in patients with cerebral infarction treated with antiplatelet therapy,and it is significantly associated with recurrent cerebral infarction.AR detected by TEG has a certain predictive value for recurrent cerebral infarction.Patients who have experienced multiple cerebral infarction are more likely to relapse than patients with primary recurrent cerebral infarction,and good medication adherence reduces the risk of recurrence. |
