Relationship Between Platelet Reactivity After Clopidogrel Treatment and Adverse Events of Patients Treated with Dual Antiplatelet Therapy After Percutaneous Coronary Intervention
Objective To investigate the relationship between platelet reactivity after clopidogrel treatment and the incidence of bleeding events and cardiovascular events of patients treated with dual antiplatelet therapy(DAPT)after percutaneous coronary intervention(PCI).Methods The clinical data of 220 patients with coronary heart disease(CHD)who visited the hospital and successfully underwent PCI from June 2019 to June 2020 were retrospectively collected.According to the platelet aggregation inhibition rate,the patients were divided into the low platelet reaction group(100 cases)and the high platelet reaction group(120 cases),and the patients were divided into the bleeding group(41 cases)and the non-bleeding group(179 cases)based on whether bleeding occurred at 12 months after PCI.The incidence of bleeding events and cardiovascular events at 12 months after PCI between the two groups was compared,the predictive value of DAPT score,PRESISE-DAPT score,platelet aggregation inhibition rate,and three combined detection on the risk of bleeding in patients were analyzed.Logistic regression analysis was used to analyze the risk factors affecting bleeding at 12 months after PCI,the nomogram model was constructed and validated.Results Twenty months after PCI,the incidence of cardiovascular events in the low platelet reaction group was 12.00%,which was significantly higher than 4.17% in the high platelet reaction group(P<0.05).The incidence of mild bleeding in the low platelet reaction group was 20.00%,which was significantly higher than 5.00% in the high platelet reaction group(P<0.05).The DAPT score in the bleeding group was significantly lower than that in the non-bleeding group(P<0.05),and the PRESISE-DAPT score and platelet aggregation inhibition rate in the bleeding group were significantly higher than those in the non-bleeding group(P<0.05).The areas under the receiver operating characteristic curve(AUC)of predicting bleeding risk by the DAPT score,PRESISE-DAPT score,platelet aggregation inhibition rate,and three combined detection were 0.833[95% CI(0.777,0.879)],0.641[95% CI(0.574,0.705)],0.891[95% CI(0.842,0.929)],and 0.949[95% CI(0.911,0.974)],respectively;the corresponding specificities were 70.39%,77.09%,69.83%,86.59%,and the sensitivities were 87.80%,48.78%,90.24%,and 92.68%,respectively.Multivariate Logistic regression analysis showed that history of gastrointestinal ulcers,DAPT score,PRESISE-DAPT score,and platelet aggregation inhibition rate were all influencing factors for bleeding at 12 months after PCI(P<0.05).The nomogram prediction model showed that for every 1 point decreased in DAPT score,the weight increased by 10 points;for every 5 points increased in the PRICE-DAPT score,the weight increased by 5.2 points;for every 2 points increased in platelet aggregation inhibition rate,the weight increased by 10 points;for history of gastrointestinal ulcer,the weight increased by 19.8 points.The Bootstrap method for internal validation showed that H-L test results were χ2=7.541,and P=0.563,indicating that the model had a good calibration degree.The Calibration curve showed good consistency between the bleeding risk predicted by the nomogram and the actual occurrence risk,with an AUC of 0.908[95% CI(0.845,0.970)],indicating that the prediction model had good differentiation.Conclusion Low platelet reactivity after clopidogrel treatment can affect the incidence of bleeding events and cardiovascular events in patients treated with DAPT after PCI.The DAPT scores,PRESISE-DAPT scores,and platelet aggregation inhibition rate have predictive values for bleeding events.
platelet reactivity after clopidogrel treatmentpercutaneous coronary interventiondual antiplatelet therapybleeding events
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