Effect Of Hyperuricemia On Platelet Inhibition Rate In Patients With Acute Coronary Syndrome After Interventional Therapy

Objective:To Study the effect of hyperuricemia on platelet inhibition rate in patients with acute coronary syndrome after stent implantation by thromboelastography.Methods:1.106 patients with acute coronary syndrome which diagnosed by Cardiology Department of the First Affiliated Hospital of Kunming Medical University from December 2017 to December 2018.Both of them were treated with percutaneous coronary intervention·They were selected and divided into hyperuricemia group(n=53)and normal uric acid group(n=53)according to whether they were complicated with hyperuricemia or not.2.Routine examination was performed before operation,and gave the loading dose of aspirin 300 mg(Bayer Company),clopidogrel sulfate 300 mg(Sanofi Company)before operation,aspirin 100 mg(Bayer Company)and clopidogrel sulfate 75 mg(Sanofi Company)were given after operation.3.Collecting the clinical baseline data of patients and make statistical analysis.Accomplishing the correlation analysis of statistical with the data which showed statistical differences such as age,sex,body mass index(BMI)and blood lipid.Discussing the relationship between serum uric acid(SUA)and ADP channel inhibition rate.Multivariate regression analysis was used in multivariate analysis,AA channel inhibition rate and ADP channel inhibition rate were dependent variables.SUA,age,sex,BMI and blood lipid were independent variables to establish regression model.Discussing the relationship between SUA and platelet inhibition rate through the multivariate linear regression.4.Preoperative routine examination was performed to improve blood routine,liver and kidney function,blood lipid,blood glucose,blood uric acid,electrocardiogram and record those results.5.Coronary angiography results were recorded during the intraoperation,and SYNTAX score was used to indicate the degree of coronary artery lesion.6.Thromboelastogram was performed on the fifth day after operation.Analysising the differences of R value,K value,alpha angle and maximum amplitude(MA),arachidonic acid(AA)channel and adenosine diphosphate(ADP)channel inhibition rate between hyperuricemia group and normal uric acid group.Results:1.The baseline data of age,sex,body mass index(BMI)and blood lipid in hyperuricemia group were statistically significant than those in normal uric acid group(P<0.05).2.The SYNTAX score and the number of multiple vessel lesions(double and three vessel lesions)in hyperuricemia group were higher than those in normal uric acid group(P<0.05).3.Thromboelastogram R and K values in hyperuricemia group were lower than those in normal uric acid group(P<0.05);Alpha angle and maximum thrombosis amplitude(MA)were higher than those in normal uric acid group(P<0.05)4.Univariate linear regression analysis showed that the correlation between SUA level and inhibition rate of ADP channel was r=0.714,P=0.000,and alpha<0.05 as the test level,difference has statistically significant.Multivariate regression analysis showed that SUA level was still correlated with inhibition rate of ADP channel(r=0.748,SUA regression coefficient-0.632,P=0.000);SUA level was correlated with AA channel inhibition rate(r=-0.612,P=0.000).Multivariate regression analysis showed that SUA level was correlated with AA channel inhibition rate(r=0.652,SUA regression coefficient-0.501,P=0.000),difference has statistically significant.Conclusion(s):1.The proportion of single and triple vessel lesions in patients with hyperuricemia is higher than that in normal uric acid group.The SYNTAX score in hyperuricemia group is higher than that in normal uric acid group.lt is suggest that the increase of serum uric acid level is related to the severity of coronary artery disease2.Hypercoagulable state exists in the blood of patients with hyperuricemia,which needs to be clinical concerned.3.High platelet reactivity exists in patients with hyperuricemia who take aspirin and clopidogrel as the method of antiplatelet therapy after PCI,which is manifested by low inhibition rate of ADP,which may be related to clopidogrel resistance but not aspirin resistance.It suggests that individualized antiplatelet therapy should be strengthened after interventional therapy for coronary heart disease to reduce the occurrence of ST and Major Adeverse Cardiovascular Events.