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|本期目录/Table of Contents|

VerifyNow P2Y12血小板反应性检测对评估冠状动脉血运重建患者的临床疗效的meta分析

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第5期
页码:
577-581
栏目:
临床研究
出版日期:
2015-05-05

文章信息/Info

Title:
Effects of VerifyNow P2Y12 test on clinical outcomes of patients with coronary revascularization: A meta-analysis
作者:
刘 畅马依彤于子翔杨毅宁李晓梅
(新疆医科大学第一附属医院心脏中心冠心病科,新疆 乌鲁木齐 830054)
Author(s):
LIU Chang MA Yi-tong YU Zi-xiang YANG Yi-ning LI Xiao-mei
(No.1Cardiology Heart Disease Department, Heart Center, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, Xinjiang, China)
关键词:
VerifyNow P2Y12氯吡格雷冠状动脉粥样硬化性心脏病Meta分析
Keywords:
VerifyNow P2Y12 clopidogrel coronary atherosclerotic heart disease meta-analysis
分类号:
R541.4;R973.2
DOI:
-
文献标识码:
A
摘要:
目的 评价VerifyNow P2Y12血小板反应性检测对使用氯吡格雷的冠状动脉血运重建患者的长期临床预后的意义。方法 计算机检索Cochrane图书馆(2014年第3期)、PubMed、EMbase、Highwire、CBM、CNKI等中外生物医学数据库。收集关于对冠状动脉血运重建患者实施VerifyNowP2Y12检测,随访时间为6~12个月的随机对照临床试验以及队列研究,检索日期截止至2014年3月。提取有效数据后采用STATA 12.0软件进行Meta分析。结果 本meta分析纳入14项研究,共计17 643名患者,结果显示:VerifyNow P2Y12检测出的血小板高反应性组的全因病死率高〔RR=1.572,95%CI(1.220,2.025),P=0.000〕,再次心肌梗死发生率高〔RR=1.981,95%CI(1.443,2.720),P=0.000〕,支架内血栓发生率高〔RR=2.205,95%CI(1.643,2.960),P=0.000〕,卒中发生率高〔RR=2.288,95%CI(1.195,4.380),P=0.012〕,而对于靶血管重建,两组结果差异无统计学意义〔RR=1.148,95%CI(0.809,1.629),P=0.439〕。结论 VerifyNow P2Y12血小板反应性检测对服用氯吡格雷患者的全因死亡、心肌梗死、支架内血栓、卒中等心血管事件有预测价值。
Abstract:
AIM To investigate the effects of VerifyNow P2Y12 test on the clinical outcomes of patients taking clopidogrel undergoing coronary revascularization. METHODS We searched the Cochrane Library (2014 Section 3), Pubmed, EMbase, Highwire, CBM, CNKI and other biomedical databases and collected data as of March 2014 of VerifyNow P2Y12 test in patients with coronary revascularization, follow-up time of 6-12 months, randomized controlled trials and cohort studies. After extracting valid data, a meta-analysis was conducted using STATA 12.0 software. RESULTS The meta-analysis included 14 studies with a total of 17 643 patients. The results showed that the detection rate of VerifyNow P2Y12 test was high in all-cause mortality (RR=1.572, 95%CI 1.220, 2.025, P=0.000), incidence of myocardial infarction (RR=1.981, 95%CI 1.443, 2.720, P=0.000), stent thrombosis rate (RR=2.205, 95%CI 1.643, 2.960, P=0.000) and incidence of stroke (RR=2.288, 95%CI 1.195, 4.380, P=0.0129). For target vessel revascularization, two sets of results showed no significant difference (RR=1.148, 95%CI 0.809, 1.629, P=0.439). CONCLUSION VerifyNow P2Y12 platelet reactivity detection has predictive value for all-cause death, myocardial infarction, stent thrombosis, stroke and other cardiovascular events in patients taking clopidogrel.

参考文献/References

[1]King SB 3rd,Smith SC Jr,Hirshfeld JW Jr,et al.2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention:a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines:2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee[J].Circulation,2008,117(2):261-295.
[2]Gurbel PA,Bliden KP,Hiatt BL,et al.Clopidogrel for Coronary Stenting:Response Variability,Drug Resistance, and the Effect of Pretreatment Platelet Reactivity[J].Circulation,2003,107(23):2908-2913.
[3]Park SJ,Park DW,Kim YH,et al.Duration of dual antiplatelet therapy after implantation of drug-eluting stents[J].N Engl J Med,2010,362(15):1374-1382.
[4]von Beckerath N,Taubert D,Pogatsa-Murray G,et al.Absorption,metabolization,and antiplatelet effects of 300-,600-,and 900-mg loading doses of clopidogrel:Results of the ISAR-CHOICE(intracoronary stenting and antithrombotic regimen:Choose between 3 high oral doses for immediate clopidogrel effect)trial[J].Circulation,2005,112(19):2946-2950.
[5]Price MJ,Coleman JL,Steinhubl SR,et al.Onset and offset of platelet inhibition after highdose clopidogrel loading and standard daily therapy measured by a point-of-care assay in healthy volunteers[J].Am J Cardiol,2006,98(5):681-684.
[6]Gurbel PA,Tantry US.Platelet function testing and genotyping improve outcome in patients treated with antithrombotic agents[J].Circulation,2012,125(10):1276-1287.
[7]Fileti L,Campo G,Valgimigli M.Latest clinical data on testing for high on-treatment platelet reactivity[J].Rev Cardiovasc Med,2011, 12(Suppl. 1):S14-S22.
[8]Bonello L,Tantry US,Marcucci R,et al.Consensus and future directions on the definition of high ontreatment platelet reactivity to adenosine diphosphate[J].J Am Coll Cardiol,2010,56(12):919-933.
[9]Youn YN,Yi G,Lee S,et al.Posttreatment platelet reactivity on clopidogrel is associated with the risk of adverse events after off-pump coronary artery bypass[J].Am Heart J,2014,167(6):818-825.
[10]Stone GW,Witzenbichler B,Weisz G,et al.Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents(ADAPT-DES):a prospective multicentre registry study[J].Lancet,2013,382(9892):614-623.
[11]Saia F,Marino M,Campo G,et al.Incidence and outcome of high on-treatment platelet reactivity in patients with non-ST elevation acute coronary syndromes undergoing percutaneous coronary intervention(from the VIP[VerifyNow and Inhibition of Platelet Reactivity]study)[J].Am J Cardiol,2013,112(6):792-798.
[12]Park DW,Ahn JM,Song HG,et al.Differential prognostic impact of high on-treatment platelet reactivity among patients with acute coronary syndromes versus stable coronary artery disease undergoing percutaneous coronary intervention[J].Am Heart J,2013,165(1):34-42.
[13]Jin HY,Yang TH,Kim DI,et al.High post-clopidogrel platelet reactivity assessed by a point-of-care assay predicts long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who underwent primary coronary stenting[J].Int J Cardiol,2013,167(5):1877-1781.
[14]罗 裕,孙文竹, 徐剑锋,等.VerifyNow-P2Y12法和光密度比浊法检测血小板高反应与预测氯吡格雷治疗老年冠状动脉性心脏病患者经皮冠状动脉介入术后临床缺血事件的意义[J].上海医学,2013,36(9):757-761.
[15]Ari H,Ozkan H,Karacinar A,et al.The effect of high-dose clopidogrel treatment in patients with clopidogrel resistance (the efficient trial)[J].Int J Cardiol,2012,157(3):374-380.
[16]Price MJ,Berger PB,Teirstein PS,et al.Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention:The GRAVITAS randomized trial[J].JAMA,2011,305(11):1097-105.
[17]Campo G,Fileti L,de Cesare N,et al.Long-term clinical outcome based on aspirin and clopidogrel responsiveness status after elective percutaneous coronary intervention:A 3T/2R (tailoring treatment with tirofiban in patients showing resistance to aspirin and/or resistance to clopidogrel) trial substudy[J].J Am Coll Cardiol,2010,56(18):1447-1455.
[18]reet 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.
[19]Lee K,Lee SW,Lee JW,et al.The significance of clopidogrel lowresponsiveness on stent thrombosis and cardiac death assessed by the verifynow p(2)y(12) assay in patients with acute coronary syndrome within 6 months after drug-eluting stent implantation[J].Korean Circ J,2009,39(12):512-518.
[20]de Miguel Castro A,Cuellas Ramon C,Diego Nieto A,et al.Post-treatment platelet responsiveness predicts long-term adverse events better than the response to clopidogrel in patients with non-ST-segment elevation acute coronary syndrome[J].Rev Esp Cardiol,2009,62(2):126-135.
[21]Marcucci R,Gori AM,Paniccia R,et al.Cardiovascular death and nonfatal myocardial infarction in acute coronary syndrome patients receiving coronary stenting are predicted by residual platelet responsiveness to ADP detected by a point-of-care assay: A 12-month follow-up[J].Circulation,2009,119(2):237-242.
[22]Price MJ,Endemann S,Gollapudi RR,et al.Prognostic significance of post-clopidogrel platelet responsiveness assessed by a point-of-care assay on thrombotic events after drug-eluting stent implantation[J].Eur Heart J,2008,29(8):992-1000.
[23]Aradi D,Komocsi A,Vorobcsuk A,et al.Prognostic significance of high on-clopidogrel platelet responsiveness after percutaneous coronary intervention: Systematic review and metaanalysis[J].Am Heart J,2010,160(3):543-551.
[24]Brar SS,ten Berg J,Marcucci R,et al.Impact of platelet reactivity on clinical outcomes after percutaneous coronary intervention. A collaborative meta-analysis of individual participant data[J].J Am Coll Cardiol,2011,58(19):1945-1954.

备注/Memo

备注/Memo:
收稿日期:2014-11-05.
基金项目:教育部“创新团队发展计划”项目资助(IRT13094)
通讯作者:马依彤,主任医师,主要从事心血管病的基础与临床研究 Email:myt-xj@163.com
作者简介:刘畅,硕士生 Email:151204701@qq.com
更新日期/Last Update: 2015-04-28