2010循环杂志残余血小板活性预测心血管风险(4)

Marcuccietal

Table1.

Age,y

Malegender,n(%)Diabetes,n(%)Smoking,n(%)Hypertension,n(%)Dyslipidemia,n(%)BMI 25kg/m2,n(%)FamilyhistoryofCAD,n(%)LVEF 40%,n(%)Renalfailure,*n(%)STEMI,n(%)ACEinhibitors,n(%)

PlateletReactivityandIschemicEvents239

ClinicalCharacteristicsofPatientsInvestigated

OverallGroup(n 683)

69(29–94)517(75.6)178(26.0)210(30.8)460(67.3)357(52.3)250(36.6)132(19.3)174(25.5)69(10.1)191(28)444(65)271(39.6)410(60)635(92.9)205(30)13141154121(17.7)248(36.3)37 26

RPR*(n 219)73(46–93)141(64.3)75(34.2)68(31.1)154(70.3)124(56.6)87(39.7)48(21.9)67(30.6)15(6.8)63(28.7)142(64.8)88(40.2)131(59.9)201(91.7)72(32.9)43739152(23.7)83(37.9)39 31

NoRPR*(n 464)

68(29–94)376(81.0)103(22.2)142(30.6)306(65.9)233(50.2)163(35.1)84(18.1)107(23.1)54(11.6)128(27.5)302(65.1)183(39.4)279(60.1)434(93.5)133(28.6)

87776369(14.8)165(35.5)37 29

P 0.005 0.005 0.005NSNSNSNSNS 0.005NSNSNSNSNSNSNS NSNSNS

-Blockers,n(%)Statins,n(%)Pumpinhibitors,n(%)GlycoproteinIIb/IIIa,n(%)No.oflesionstreatedNo.ofvesselstreatedDrug-elutingstent,n(%)Bifurcationlesion,n(%)Totalstentlength,mm

BMIindicatesbodymassindex;CAD,coronaryarterydisease;LVEF,leftventricularejectionfraction;andSTEMI,ST-elevationMI.*RPRasdefinedbyPRUabovetheoptimalcutoffpointbyreceiveroperatingcharacteristiccurveanalysis(PRU 240);renalinsufficiencywasdefinedbycreatininelevels 2.0mg/dL. RPRvsnoRPR.

likelytobediabetic,andmorelikelytohavereducedleftventricularejectionfractionthanpatientswithoutRPR(Table1).Theevent-freesurvivalcurvesforcardiovasculardeathandnonfatalMIaccordingtothepresenceofRPRareshowninFigures2and3.OnunivariateCoxregressionanalysis,RPRmeasuredbyVerifyNow(cutoff 240PRU)wasassociatedwithasignificantlyhigherriskofbothcardiovasculardeath(hazardratio[HR]2.38,95%CI1.15to5.20,P 0.031)andnonfatalMI(HR2.73,95%CI1.54to5.01,P 0.006),whereasnosignificantassociationwasdetectedwithtarget-vesselrevascularization(HR1.48,95%CI0.78to2.78,P 0.225).Theseresultswereconfirmedafteradjustmentforcardiovascularriskfactors,renalfailure,reducedejectionfraction,multivesseldisease,totalstentlength,bifurcationlesions,numberoflesionstreated,typeofstentused,anduseofglycoproteinIIb/IIIainhibitors(cardiovasculardeath:HR2.55,95%CI1.08to6.07,P 0.034;nonfatalMI:HR3.36,95%CI1.49to7.58,P 0.004).

Table2.

ClinicalOutcomeat12-MonthFollow-Up

OverallGroup(n 683)

CardiovasculardeathandnonfatalMI,n(%)Cardiovasculardeath,n(%)NonfatalMI,n(%)

Target-lesionrevascularization,n(%)*RPRasdefinedbyPRU 240.

44(6.4%)24(3.5)27(3.9)40(5.8)

TheHRforcardiovasculardeathandnonfatalMIwasalsoanalyzedwithrespecttoPRUquartiles(Figure4).Thehighestquartile,whichcorrespondedtoPRUvalues 258,wasassociatedwithasignificantlyincreasedriskforische-micrecurrences(HR3.6,95%CI1.5to9.09,Pfortrend0.005).

WealsotestedtheassociationbetweenRPRand12-monthfollow-upcardiovasculareventsusingthecutoffpreviouslycalculatedinthestudybyPriceetal8(PRUvalues 235).Twohundredthirty-onepatients(33.8%)hadPRUvalues 235;onunivariateCoxregressionanalysis,PRU 235wasassociatedwithanincreasedriskofbothcardiovasculardeath(HR2.37,95%CI1.06to5.30,P 0.035)andnonfatalMI(HR2.94,95%CI1.37to6.34,P 0.006).Theseresultswereconfirmedafteradjustmentforclassicandproceduralcardio-vascularriskfactors(HR2.41,95%CI1.01to5.72,P 0.046andHR3.12,95%CI1.38to7.02,P 0.006,respectively,forcardiovasculardeathandnonfatalMI).

RPR*(n 219)27(12.3)13(5.9)16(7.3)16(7.3)

NoRPR(n 464)

17(3.6)11(2.4)11(2.4)24(5.2)

HR(95%CI)2.52(1.30–5.13)2.38(1.15–5.20)2.73(1.54–5.01)1.48(0.78–2.78)

P0.0110.0310.0060.225