Abstract
Background: Platelet reactivity is closely associated with adverse events in percutaneous coronary intervention (PCI) patients. Inflammation plays a crucial role in the development of coronary heart disease (CHD).Aim: To investigate the association of inflammatory biomarkers such as leukocyte count and high-sensitivity C reactive proteins (hs-CRP) with platelet reactivity in PCI patients treated with clopidogrel.Method: We examined 10,724 consecutive PCI patients in Fuwai hospital from January 2013 to December 2013. High on-treatment platelet reactivity (HTPR) was defined as adenosine diphosphate (ADP)-induced platelet maximum amplitude [MA(ADP)] of thromboelastogram (TEG) > 47 mm, and low on-treatment platelet reactivity (LTPR) MA(ADP) < 31 mm.Results: Finally, 6,772 PCI patients treated with clopidogrel who had the results of postoperative TEG were enrolled. Among them, 2,070 (30.57%) presented HTPR and 2,568 (37.92%) presented LTPR. As for LTPR, multivariate logistic regression showed that leukocyte count (OR: 1.153, 95% CI 1.117–1.191) and hs-CRP (OR: 0.920, 95% CI 0.905–0.936) were independent predictors, along with diabetes mellites, hemoglobin, platelet count and glucose. As for HTPR, multivariate logistic regression showed that leukocyte count (OR: 0.885, 95% CI 0.854–0.917) and hs-CRP (OR: 1.094, 95% CI 1.077–1.112) were independent predictors, along with sex, hemoglobin, platelet count and glucose.Conclusions: This was the first large real-world study reporting that both leukocyte count and hs-CRP were the independent factors for platelet reactivity in PCI populations treated with clopidogrel, among which higher leukocyte count was associated with more LTPR while higher hs-CRP was associated with more HTPR, providing new insights on individualized antiplatelet therapy.
Highlights
Platelet reactivity varies in percutaneous coronary intervention (PCI) patients treated with clopidogrel [1], and platelet participates in thrombosis and bleeding events
Patients were divided into three groups according to the value of MA(ADP): low on-treatment platelet reactivity (LTPR) (2,568, 37.92%), normal on-treatment platelet reactivity (NTPR) (2,134, 31.51%) and high on-treatment platelet reactivity (HTPR) (2,070, 30.57%)
Comparison was performed among the three groups: sex, age, MA(ADP), leukocyte count, hs-CRP, smoking history, acute coronary syndrome (ACS), hypertension, diabetes mellitus, prior myocardial infarction, prior PCI, hemoglobin, platelet count, low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), glucose and estimated glomerular filtration rate (eGFR) were significantly different (P all
Summary
Platelet reactivity varies in percutaneous coronary intervention (PCI) patients treated with clopidogrel [1], and platelet participates in thrombosis and bleeding events. Previous studies have established in patients with coronary heart disease (CHD) that high on-treatment platelet reactivity (HTPR) is an independent risk factor for thrombotic events [2,3,4], while low on-treatment platelet reactivity (LTPR) is an independent risk factor for bleeding events [5,6,7,8]. Previous studies have shown that elevated leukocyte count [14,15,16,17] and hs-CRP [18,19,20] were associated with bleeding and thrombotic adverse events in PCI patients, the mechanism of the increased risk is unknown. Platelet reactivity is closely associated with adverse events in percutaneous coronary intervention (PCI) patients. Inflammation plays a crucial role in the development of coronary heart disease (CHD)
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