经皮冠状动脉介入治疗后血小板聚集率高的患者强化抗血小板治疗的研究

Effects of intensive antiplatelet therapy in patients with high platelet aggregability after percutaneous coronary intervention

目的研究经皮冠状动脉介入治疗(PCI)后血小板聚集率仍然高的患者强化抗血小板治疗与主要心脏事件的关系。方法选择2004年1月至2006年6月我院住院进行择期 PCI 的冠心病患者1556例,服药前、术后24小时、28天检测二磷酸腺苷(ADP)诱导的血小板聚集率。其中有402例患者[男178例,女224例,平均年龄(57.34±6.47)岁]术后血小板聚集率仍然高,其24小时的血小板聚集度与基线(服药前)的绝对值<30%。把这部分患者随机分为两组,对照组(n=201)继续服用阿司匹林100 mg、氯吡格雷75 mg;治疗组(n=201)除继续服用阿司匹林100 mg、氯吡格雷75mg,每天加西洛他唑200 mg,分两次服用。连续应用6个月,观察两组患者6个月主要心脏不良事件(包括死亡、非致死性急性心肌梗死、急性或亚急性血栓、靶血管重建、脑卒中)以及出血等不良事件的发生率。结果28天血小板聚集的抑制<30%患者对照组有89.6%(180/201),治疗组有9.4%(19/201),两组相比,差异有统计学意义(P<0.05)。两组均无急性血栓发生;亚急性血栓对照组有3.0%(6/201),治疗组有0.5%(1/201),两组相比,差异无统计学意义(P>0.05);对照组有2例死亡,治疗组无死亡;两组均未发生脑卒中;非致死性急性心肌梗死对照组1.5%(3/201),治疗组0.5%(1/201);两组相比,差异无统计学意义(P>0.05);靶血管重建对照组有15.9%(32/201),治疗组6.5%(13/201),两组相比,差异有统计学意义(P<0.01);出血的发生率对照组4.0%(8/201),治疗组6.0%(12/201),两组相比,差异无统计学意义(P>0.05)。主要心脏事件的累计危险率治疗组低于对照组,差异有统计学意义(P<0.05)。结论 PCI 后应用抗血小板药物,血小板聚集率经治疗后仍然高(即血小板聚集抑制<30%)的患者,强化抗血小板治疗可以减少主要心脏事件的累计危险率,而没有增加出血并发症。

Objective Post pereutaneous coronary intervention （PCI）major cardiac event rate is high in patients with high platelet aggregability. We observed the effects of intensive antiplatelet therapy in these patients. Methods ADP-indueed platelet inhibition rates were less than 30% after 24 h treatment with Clopidogrel （300 mg） in 402 patients out of 1556 patients who underwent PCI in our institute between January 2004 to June 2006. These patients were randomly divided into control group （ Clopidogrel 75 mg/d and aspirin 100 rag/d, n = 201 ） or treatment group （ Clopidogrel 75 mg/d and aspirin 100 mg/d plus eilostazol 200 mg/d, n = 201 ）. Major adverse cardiac events were analyzed after 6 months treatments. Results Patients with ADP-indueed platelet inhibition, rates 〈 30% were significantly lower in treatment group compared to control group after 28 days treatments （ 9.4% vs. 89. 6% , P 〈 0. 05 ）. Thrombosis complication （ 0. 5% vs. 3.0% ） , death （ 0 vs. 1.0% ） , non-fatal myocardial infarction （ 0. 5% vs. 1.5% ） , hemorrhagic （ 6% vs. 4% ） rates were similar between treatment and control group while target vessel revaseularization rate was significantly lower in treatment group compared to control group （6. 5% vs. 15. 9%, P 〈 0. 05 ）. Total MACE rate was therefore significantly lower in treatment group than that in control group （ 13.5% vs. 25.4%, P 〈 0.05 ） . Conclusion Intensive anti-platelet treatment could significandy reduce major cardiac event rates in patients with high platelet aggregability after percutaneous coronary intervention.