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目的探讨以受试者工作特征曲线(ROC曲线)确定经皮冠状动脉介入治疗(PCI)术后高血小板聚集率(血小板低反应)与缺血性事件发生的关系。方法入选278例急性冠脉综合征(ACS)患者于PCI术后及随访期1个月分别行二磷酸腺苷(ADP)诱导血小板聚集率(ADP-PG)检测,观察院内围术期心肌梗死及术后6个月随访期内主要不良心脏事件(MACE);行ROC曲线分析,以最佳预测值分为血小板正常反应和血小板低反应组,观察组间MACE发生情况。结果 ROC曲线提示术后ADP-PG≥47.5%为血小板低反应组(曲线下面积=0.66,95% CI:0.57～0.75,P<0.01),共有81例(29.1%)患者;院内及6个月随访期共发生MACE39例(14.0%),随访期MACE发生率在血小板正常反应组和低反应组分别为4.6%(9/197)和11.1%(9/81),OR=2.61,P=0.04,低反应组更容易出现MACE。围术期心肌梗死在两组间分别为6.6%(13/197)和14.8%(12/81),OR=2.46,P=0.03,血栓性事件在两组间差异有统计学意义(P=0.03)。结论术后血小板低反应与PCI术后缺血性事件高发生率相关,监测ADP-PG对发现PCI术后高危人群有帮助。
Objective To investigate the relationship between platelet aggregation (thrombocytopenia) and ischemic events after percutaneous coronary intervention (PCI) by using receiver operating characteristic curve (ROC curve). Methods A total of 278 patients with acute coronary syndrome (ACS) were enrolled in this study. ADP-induced platelet aggregation (ADP-PG) And the main adverse cardiac events (MACE) during the follow-up period of 6 months after operation. The ROC curve analysis was performed and the best predictive value was divided into platelet normal reaction and platelet low response group. The incidence of MACE between the two groups was observed. Results The ROC curve suggested that postoperative ADP-PG≥47.5% was in the platelet low response group (area under the curve = 0.66, 95% CI: 0.57-0.75, P <0.01) The incidence of MACE at follow-up was 4.6% (9/197) and 11.1% (9/81), respectively, OR = 2.61, P = 0.04, low reaction group is more prone to MACE. The rates of perioperative myocardial infarction were 6.6% (13/197) and 14.8% (12/81) respectively in the two groups, OR = 2.46, P = 0.03. There was significant difference in thrombotic events between the two groups (P = 0.03). Conclusions Postoperative platelet hyporesponse is associated with a high incidence of ischemic events after PCI. Monitoring ADP-PG may be helpful in identifying high-risk patients after PCI.