2010循环杂志残余血小板活性预测心血管风险(7)

242CirculationJanuary20,2009

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CLINICALPERSPECTIVE

Agrowingbodyofevidenceshowsthataninvitroresidualplateletreactivity(RPR)inpatientsundergoingdual-antiplatelet(aspirinplusclopidogrel)treatmentisassociatedwithanincreasedriskofadversecardiovasculareventsinhigh-riskvascularpatients.Lighttransmittanceaggregometryisconsideredthestandardmethodforassessmentofplateletfunction,butlogisticproblemsmakeitsroutineusedifficult.Inrecentyears,point-of-careassaysofplateletfunctionhavebecomeavailable,includingtheVerifyNowP2Y12system,whichprovidesvaluesofRPRafterADPstimuluscorrelatedwiththosefoundbylighttransmittanceaggregometryinducedbyADP.In683patientswithacutecoronarysyndrometreatedbypercutaneouscoronaryintervention,wesoughttoverifywhethertheVerifyNowP2Y12assayisabletopredictclinicalrecurrences,andwefoundthatRPRtoADPmeasuredbyapoint-of-careassayisanindependentpredictorofcardiovasculardeathandnonfatalmyocardialinfarctionat12-monthfollow-up.Theavailabilityofasimpletestforassessmentofthisbiologicalentity(persistentinvitroplatelethyperreactivitywiththerapy)inthepanelofclinical,laboratory,andproceduralriskfactorsmayallowforbetterriskstratificationandidentificationofpatientsinwhomanaggressivebloodislikelytoplayakeyroleinmakingthepatientavulnerablepatient.