Prognosis prediction of thrombelastography in patients undergoing percutaneous coronary intervention

doi:10.3969/j.issn.1673-8640.2015.06.006

Abstract

Abstract: Objective

To evaluate the prognosis prediction of thrombelastography (TEG) in patients undergoing percutaneous coronary intervention (PCI).

Methods

The data from 115 patients undergoing PCI were collected, and the patients were classified into 2 groups according to maximum amplitude-adenosine diphosphate (MA-ADP), MA-MDP<50 mm group and MA-ADP≥50 mm group. The percentages of adverse cardiovascular events, reinfarction and restenosis were followed up for 1 year.

Results

There was no statistical significance in the clinical characteristics of the 2 groups (P>0.05). Logistic regression analysis showed that MA-ADP was the risk factor of adverse cardiovascular event recurrence in patients undergoing PCI (OR=3.547, 95% CI: 1.103-11.412, P=0.034). Compared with MA-ADP normal patients (<50mm), the incidences of adverse cardiovascular events and reinfarction in patients with high MA-ADP (≥50mm) significantly increased (P<0.05).

Conclusions

MA-ADP can predict the prognosis after PCI. MA-ADP=50 can be the cut-off point in the prognosis prediction of patients undergoing PCI.

Key words: Thrombelastography, Percutaneous coronary intervertion, Maximum amplitude-adenosine diphosphate, Adverse cardiovascular event, Prognosis prediction

CLC Number:

R446.11

GU Meixiu, SUN Lin, WANG Beili, REN Xiaoci, YAO Ke, GUO Wei, PAN Baishen. Prognosis prediction of thrombelastography in patients undergoing percutaneous coronary intervention[J]. Laboratory Medicine, 2015, 30(6): 571-574.

Figures/Tables 4

References 9

[1]	TEO K, LEAR S, ISLAM S, et al.Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study[J].JAMA, 2013, 309(15):1613-1621.
[2]	TANTRY US, GURBEL PA.Antiplatelet drug resistance and variability in response: the role of antiplatelet therapy monitoring[J].Curr Pharm Des, 2013, 19(21):3795-3815.
[3]	HOBSON AR, PETLEY GW, DAWKINS KD, et al.A novel fifteen minute test for assessment of individual time-dependent clotting responses to aspirin and clopidogrel using modified thrombelastography[J].Platelets, 2007, 18(7):497-505.
[4]	XU L, WANG L, YANG X, et al.Platelet function monitoring guided antiplatelet therapy in patients receiving high-risk coronary interventions[J].Chin Med J (Engl),2014,127(19):3364-3370.
[5]	GURBEL PA, BLIDEN KP, GUYER K, et al.Platelet reactivity in patients and recurrent events post-stenting: results of the PREPARE POST-STENTING Study[J].J Am Coll Cardiol, 2005, 46(10):1820-1826.
[6]	MCCRATH DJ, CERBONI E, FRUMENTO RJ, et al.Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction[J].Anesth Analg, 2005, 100(6):1576-1583.
[7]	GURBEL PA, BLIDEN KP, NAVICKAS IA,et al.Adenosine diphosphate-induced platelet-fibrin clot strength: a new thrombelastographic indicator of long term poststenting ischemic events[J].Am Heart J, 2010, 160(2):346-354.
[8]	GURBEL PA, BLIDEN KP, GUYER K, et al.Platelet reactivity in patients and recurrent events post-stenting:results of the PREPARE POST-STENTING Study[J].J Am Coll Cardiol, 2005, 46(10):1820-1826.
[9]	BREET NJ, VAN WERKUM JW, BOUMAN HJ et al. Comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation[J].JAMA, 2010, 303(8):754-762.

MA-ADP (mm)	例数	年龄(岁)	性别[例(%)]	PPI [例(%)]	他汀类药物 [例(%)]	β受体阻断剂 [例(%)]	ACE抑制剂 [例(%)]
MA-ADP (mm)	例数	年龄(岁)	男	PPI [例(%)]	他汀类药物 [例(%)]	β受体阻断剂 [例(%)]	ACE抑制剂 [例(%)]	女
<50	101	65.4±9.5	91(90.1)	10(9.9)	1(1.0)	72(71.3)	76(75.2)	39(38.6)
≥50	14	68.4±13.1	10(71.4)	4(28.6)	0(0.0)	12(85.7)	10(71.4)	9(64.3)
P值		0.307	0.068	0.999	0.346	0.749	0.068
MA-ADP (mm)	例数	高血压 [例(%)]	糖尿病 [例(%)]	吸烟 [例(%)]	CVD [例(%)]	血脂异常 [例(%)]	STEMI [例(%)]	左前降支梗死 [例(%)]
<50	101	68(67.3)	31(30.7)	55(54.5)	6(5.9)	10(9.9)	39(38.6)	61(60.4)
≥50	14	8(57.1)	4(28.6)	7(50.0)	0(0.0)	1(7.1)	8(57.1)	8(57.1)
P值		0.451	0.999	0.782	0.999	0.999	0.186	0.816
MA-ADP (mm)	例数	回旋支梗死 [例(%)]	右冠状动脉梗死 [例(%)]	TIMI分级 [例(%)]	支架数	支架长度 (mm)	左心室射血分数(%)	PLT (×10⁹/L)
<50	101	28(27.7)	32(31.7)	99(98.0)	1.9±1.0	51.3±29.3	62.0±9.4	192.9±57.2
≥50	14	5(35.7)	7(50.0)	14(100.0)	1.9±0.9	51.0±26.6	58.2±9.9	183.4±72.1
P值		0.536	0.175	0.999	0.966	0.969	0.160	0.572

MA-ADP (mm)	例数	年龄(岁)	性别[例(%)]	PPI [例(%)]	他汀类药物 [例(%)]	β受体阻断剂 [例(%)]	ACE抑制剂 [例(%)]
MA-ADP (mm)	例数	年龄(岁)	男	PPI [例(%)]	他汀类药物 [例(%)]	β受体阻断剂 [例(%)]	ACE抑制剂 [例(%)]	女
<50	101	65.4±9.5	91(90.1)	10(9.9)	1(1.0)	72(71.3)	76(75.2)	39(38.6)
≥50	14	68.4±13.1	10(71.4)	4(28.6)	0(0.0)	12(85.7)	10(71.4)	9(64.3)
P值		0.307	0.068	0.999	0.346	0.749	0.068
MA-ADP (mm)	例数	高血压 [例(%)]	糖尿病 [例(%)]	吸烟 [例(%)]	CVD [例(%)]	血脂异常 [例(%)]	STEMI [例(%)]	左前降支梗死 [例(%)]
<50	101	68(67.3)	31(30.7)	55(54.5)	6(5.9)	10(9.9)	39(38.6)	61(60.4)
≥50	14	8(57.1)	4(28.6)	7(50.0)	0(0.0)	1(7.1)	8(57.1)	8(57.1)
P值		0.451	0.999	0.782	0.999	0.999	0.186	0.816
MA-ADP (mm)	例数	回旋支梗死 [例(%)]	右冠状动脉梗死 [例(%)]	TIMI分级 [例(%)]	支架数	支架长度 (mm)	左心室射血分数(%)	PLT (×10⁹/L)
<50	101	28(27.7)	32(31.7)	99(98.0)	1.9±1.0	51.3±29.3	62.0±9.4	192.9±57.2
≥50	14	5(35.7)	7(50.0)	14(100.0)	1.9±0.9	51.0±26.6	58.2±9.9	183.4±72.1
P值		0.536	0.175	0.999	0.966	0.969	0.160	0.572

项目	OR(95%CI)	P值
年龄	1.013 (0.9751.052)	0.511
性别	0.244 (0.0521.148)	0.074
PPI	0.000 (0.0000.000)	0.999
他丁类药物	1.359 (0.5693.247)	0.490
β受体阻断剂	0.798 (0.3381.887)	0.608
ACE抑制剂	0.741 (0.3421.606)	0.447
高血压	0.933 (0.4212.069)	0.865
糖尿病	0.985 (0.4332.240)	0.971
吸烟	0.621 (0.2901.329)	0.220
CVD	1.725 (0.3328.955)	0.516
血脂异常	0.915 (0.4241.977)	0.563
STEMI/NSTEMI	0.871 (0.4701.617)	0.822
左前降支梗死	0.650 (0.3011.402)	0.272
回旋支梗死	2.288 (1.0025.228)	0.050
右冠状动脉梗死	0.908 (0.4072.023)	0.813
TIMI分级	0.000 (0.0000.000)	0.999
支架数	1.239 (0.8441.817)	0.274
支架长度	1.009 (0.9961.022)	0.181
左心室射血分数	1.015 (0.9741.057)	0.481
PLT	0.997 (0.9901.003)	0.330
MA-ADP	3.547 (1.10311.412)	0.034
Inh-ADP	1.001 (0.9861.016)	0.877
MA-AA	1.690 (0.10327.742)	0.713
Inh-AA	0.000 (0.0000.000)	0.999

项目	OR(95%CI)	P值
年龄	1.013 (0.9751.052)	0.511
性别	0.244 (0.0521.148)	0.074
PPI	0.000 (0.0000.000)	0.999
他丁类药物	1.359 (0.5693.247)	0.490
β受体阻断剂	0.798 (0.3381.887)	0.608
ACE抑制剂	0.741 (0.3421.606)	0.447
高血压	0.933 (0.4212.069)	0.865
糖尿病	0.985 (0.4332.240)	0.971
吸烟	0.621 (0.2901.329)	0.220
CVD	1.725 (0.3328.955)	0.516
血脂异常	0.915 (0.4241.977)	0.563
STEMI/NSTEMI	0.871 (0.4701.617)	0.822
左前降支梗死	0.650 (0.3011.402)	0.272
回旋支梗死	2.288 (1.0025.228)	0.050
右冠状动脉梗死	0.908 (0.4072.023)	0.813
TIMI分级	0.000 (0.0000.000)	0.999
支架数	1.239 (0.8441.817)	0.274
支架长度	1.009 (0.9961.022)	0.181
左心室射血分数	1.015 (0.9741.057)	0.481
PLT	0.997 (0.9901.003)	0.330
MA-ADP	3.547 (1.10311.412)	0.034
Inh-ADP	1.001 (0.9861.016)	0.877
MA-AA	1.690 (0.10327.742)	0.713
Inh-AA	0.000 (0.0000.000)	0.999