ОСОБЕННОСТИ ВЫСОКОЙ ОСТАТОЧНОЙ РЕАКТИВНОСТИ ТРОМБОЦИТОВ У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА В УСЛОВИЯХ РЕПЕРФУЗИОННОЙ ТЕРАПИИ

Abstract

The aim of the study was to assess the incidence of high residual platelet reactivity in patients with myocardial infarction (MI), depending on the age and reperfusion therapy at different times from the onset of MI. Methods. The study included 129 patients with acute Q-MI divided into subgroups (SG) depending on age: SG1 (31-44 years) – 14 persons (10.8%), SG2 (45-59 years) – 54 (41,9%), SG3 (60–74 years) – 61 (47,3%). All patients received thrombolytic therapy (TLT), and then 99 patients underwent delayed percutaneous coronary intervention (PCI). Platelet aggregation was assessed using a Multiplate impedance aggregometer (Germany) with several aggregation inducers. The data were analyzed using the STATISTICA 10.0 package and R 4.1 programming language. Results. The analysis of aggregatograms in patients of the general group revealed the following indicators: 1ASPI-test 19.0 [11.0; 50.5] U, 2ASPI-test 26.0 [18.0; 36.0] U, 3ASPI-test 21.0 [14.0; 30.0] U (p = 0.0003); 1ADP-test 29.0 [16.0; 46.0] U, 2ADP-test 35.0 [25.0; 48.0] U, 3ADP-test 27.0 [21.0; 40.5] U (p = 0.0012); 1TRAP-test 76.0 [57.0; 100.0] U, 2TRAP-test 100.0 [83.5; 116.5] U, 3TRAP-test 90.0 [74.5; 108.0] U (H= 17.82, p< 0.00001). Elevated values of the aggregatogram indicating the presence of high residual platelet reactivity (HRPR) (insufficient response to antiplatelet therapy) were initially detected in 43 patients (33.3%) according to ASPI-test, in 29 patients (22.5%) according to ADP- test, in 20 patients (15.5%) according to ASPI-test +ADP-test, upon the first follow-up examination – in 46 patients (35.6%) according to ASPI-test, in 31 patients (24.0%) according to ADP-test , in 18 patients (13.9%) according to ASPI-test +ADP-test, upon the third follow-up examination, in 30 patients (23.3%) according to ASPI-test, in 20 patients (15.5%) according to ADP-test, in 12 patients (9.3%) by ASPI-test +ADP-test. Thedynamics of changes of the aggregatogram and HRPR in the age subgroups had a similar pattern. Conclusion. The study revealed a high percentage of patients with MI with an insufficient response to acetylsalicylic acid and clopidogrel at dif- ferent times from the onset of MI. There were no differences in the indicators of the aggregatogram depending on the age of the patients. There were no differences in the indicators of the aggregatogram depending on the type of reperfusion therapy performed (only TLT or TLT + PCI). There were no differences in the indicators of the aggregatogram depending on the type of implanted stents.