氯吡格雷联合阿司匹林用于冠状动脉粥样硬化性心脏病患者经皮冠状动脉介入术后抗血小板治疗的疗效与预后相关性分析

Analysis of the efficacy and prognosis of Clopidogrel combined with Aspirin for antiplatelet therapy in patients with coronary atherosclerotic heart disease after percutaneous coronary intervention

目的探讨氯吡格雷联合阿司匹林用于冠状动脉粥样硬化性心脏病(CAD)患者经皮冠状动脉介入术(PCI)后抗血小板的疗效与预后相关性。方法入选2019年1月至2019年8月期间某院心血管内科CAD住院患者408例,行PCI术后予以氯吡格雷联合阿司匹林双联抗血小板治疗,即规律服用阿司匹林100 mg/d联合氯吡格雷75 mg/d。用药前及用药后均采用光学比浊法(LTA)测定血小板聚集率(PA),包括阿司匹林抗血小板反应性(LTA_(AA))及氯吡格雷抗血小板反应性(LTA_(ADP))。并根据PA结果进行分组,将LTA_(AA)≥20%定义为阿司匹林抵抗(AR),LTA_(ADP)值≥70%定义为氯吡格雷抵抗(CR)。所有患者随访6~12个月,观察心血管事件发生率。结果根据LTA法测定结果,将入选患者分为CR组和非氯吡格雷抵抗(NCR)组,入选患者中无AR。其中CR组为101例,NCR组307例,CR发生率为24.8%。所有入院患者中共有46例患者发生心血管事件,其中CR组患者中心血管事件发生17例(16.8%),NCR组患者中心血管事件发生率为29例(9.4%),CR组患者发生心血管事件发生风险显著高于NCR组(OR=1.940,95%CI:1.016~3.703,P<0.05)。多因素COX回归分析提示,吸烟因素、Grace评分及CR为CAD患者PCI术后发生心血管事件的风险因素。结论氯吡格雷联合阿司匹林用于CAD患者PCI术后抗血小板治疗安全有效;CR与心血管事件发生风险相关。

Objective To investigate the correlation between the efficacy and prognosis of Clopidogrel combined with Aspirin in patients with coronary atherosclerotic heart disease(CAD)after percutaneous coronary intervention(PCI).Methods A total of 408 hospitalized CAD patients in the hospital were enrolled in this study from January 2019 to August 2019.All the included patients underwent PCI and received dual antiplatelet therapy with Aspirin(100 mg/d)and Clopidogrel(75 mg/d).Platelet aggregation(PA)rate was determined in all the CAD patients using light transmittance aggregometry(LTA)method.Antiplatelet response to Aspirin and Clopidogrel was tested using LTA_(AA)and LTA_(ADP),respectively.Then,patients were divided into two groups according to PA;Aspirin resistance(AR)was defined as LTA_(AA)≥20%,Clopidogrel resistance(CR)was defined as LTA_(ADP)≥70%.All the patients were followed up for 6 to 12 months to observe the incidence of cardiovascular events.Results Our results showed that 101 patients were in the CR group,while 307 patients were in non-Clopidogrel resistance(NCR)group,thus the incidence of CR was 24.8%.The incidence of AR was 0%.Adverse cardiovascular events occurred in 46 patients overall,among which 17(16.8%)were in CR group,and 29 patients(9.4%)were in the NCR group.The incidence of cardiovascular events in CR group was significantly higher than that in NCR group(OR=1.940,95%CI:1.016-3.703,P<0.05).COX regression analysis indicated that smoking,Grace score and CR were risk factors for adverse cardiovascular events.Conclusion The dual antiplatelet therapy of Clopidogrel and Aspirin has been proved effective and safe for CAD patients after PCI.Notably,CR is associated with increased risk of adverse cardiovascular events.