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对血小板功能测试进行比较,以预测冠状动脉支架植入患者的临床结果
Nicoline J Breet1, Jochem W van Werkum, Heleen J Bouman
1Department of Cardiology, St Antonius Hospital, PO Box 2500, 3435 CM Nieuwegein, The Netherlands.
JAMA
|February 25, 2010
概括
冠状动脉支架植入后高治疗血小板反应与不良事件有关. 几项血小板功能测试显示了这些事件的适度预测能力,但无法预测出血风险.
科学领域:
- 心血管医学 心血管医学
- 临床药理学 临床药理学
- 血液学 血液学 血液学
背景情况:
- 治疗时高血小板反应率 (HPR) 是冠状动脉支架植入后动脉血事件的已知危险因素.
- 在接受支架的患者中预测临床结果需要对血小板功能进行可靠的评估.
研究的目的:
- 评估多重血小板功能测试对冠状动脉支架后接受克洛皮多格雷尔的患者临床结果的预测能力.
- 评估这些测试对预测主要不良心血管和出血事件的能力.
主要方法:
- 一项前性,观察性,单中心的队列研究包括1069名接受选择性冠状动脉支架的患者.
- 在治疗过程中,使用光传导聚合计,P2Y12验证,血小板工作,IMPACT-R和PFA-100系统来评估血小板反应性.
- 接收器操作特征 (ROC) 曲线分析确定了HPR和测试歧视的截止值.
主要成果:
- 在1年的随访期内,通过光传导度聚合计,Verify Now,血小板工作和Innovance PFA P2Y评估的HPR与初级终点 (死亡,心肌梗塞,支架血栓,中风的综合) 的较高发病率有关.
- ROC分析表明光传导度聚合计,Verify Now和血小板作业的适度能力在具有和没有主要终点的患者之间进行歧视.
- 在IMPACT-R和西门子PFA原蛋白/ADP检测中,没有显示出差异化能力. 没有一项经过测试的血小板功能测试能够预测出血风险.
结论:
- 光传导聚合计,Verify Now,血小板工作和Innovance PFA P2Y与支架后不良缺血事件有显著的关联.
- 这些血小板功能测试对缺血事件的预测准确性是适度的.
- 目前的血小板功能测试不能可靠地识别患有血栓植入后出血风险增加的患者.
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