| Objective:⑴To assess antiplatelet effect of a combined loading regimen with clopidogrel plus aspirin in coronary artery disease(CAD) patients with clopidogrel resistance;⑵We peformed a retrospective clinical study to observe clinical outcomes of CAD patients undergoing percutaneous coronary intervention(PCI) with drug-eluting stent(DES) implantation and attempt to provide a new evidence-based medical evidence in improving the clinical prognosis with this combined regimen.Methods:⑴All CAD patients scheduled for drug-eluting stent implantation at Department of Cardiovascular Medicine of the First Affiliated Hospital of Soochow University and the Nanjing First Hospital between October 2009 and February 2010, were measured the ADP-induced maximal platelet aggregation rates by light transmittance aggregometry before and 24 hours after taking the first time of 75 mg clopidogrel. Patients having≤10% inhibition of platelet aggregation were defined as clopidogrel resistance patients, and finally 52 petients were selected. The 52 patients of this study were divided into 2 groups depending on the Loading regimens received a 300-mg clopidogrel alone(single group) or a concomitant use of 300-mg clopidogrel and 300-mg aspirin(combined group) 6-24 hours before Primary percutaneous coronary intervention. The maximal platelet aggregation rates were measured again 72 hours after coronary stenting, Using Independent-Samples T Test analysis compared the inhibitions of platelet aggregation.⑵Retrospective cohort study of 551 patients with coronary artery disease undergoing percutaneous coronary intervention with drug-eluting stent implantation received a loading regimen of 300 mg clopidogrel alone(single group) or 300 mg clopidogrel combined with 300 mg aspirin(combined group) 6-24 hours before the primary PCI and discharged from the Nanjing First Hospital of Nanjing Medical University and the First Affiliated Hospital of Soochow University between Jan 1, 2007 and Dec 31, 2007. All clinical features before, during, and after percutaneous coronary intervention were manually abstracted by trained abstractors using standardized reporting forms and definitions, Subsequently all patients corresponding to the inclusion criteria performed a 24 -month follow-up. The statistical methods were used to compare the clinical prognosis, and Cox's proportional-hazards models were used to assess relative risks of major adverse cardiovascular events in all patients, Finally, to identify independent predictors of major adverse cardiovascular events after Percutaneous coronary intervention with drug-eltuing stent implantation at 2 years.Results:⑴Comparing 23 patients in the single group to the combined group of 29 patients with clopidogrel resistance, There was no significant difference on baseline characteristics such as age, gender and other factors (p> 0.05), as well as there wasn't a significant difference in baseline platelet aggregation rate (52.90%±9.69% vs 51.13%±9.57%, p = 0.514), But 72 hours after receiving different loading regimens, The inhibition of platelet aggregation of the combined group was significantly higher than the single group (38.21±15.11 vs 29.31±14.00, p = 0.034).⑵Retrospective study of two groups, Comparing the single group (226 cases) with the combined group (325 cases), exhibited that there was a significant difference with respect to clinical diagnosis, such as unstable angina(55.3% vs 43.7%), acute myocardial infarction (21.7% vs 36.9%), P <0.01. No significant statistical differences in smoking history, hypertension, diabetes and other baseline clinical characteristics were seen between the two groups. The follow-up results during 2 years showed that the first 1 month and 8 months after coronary stenting had higher incidence of major adverse cardiovascular events in both two groups, and the incidence of major adverse cardiovascular events from 6 to 12 months after PCI was significantly higher than other periods within 2 years. The short term (1-6months) incidence of major adverse cardiovascular events was significantly lower in the combined group as compared with the single group (1.6% vs 4.9%, P = 0.024), particularly in reducing the rate of recurrent myocardial infarction. There wasn't a significant difference in the incidence of major adverse cardiovascular events at the remaining periods within 2 years (Single 13.27% vs Combined 12.92%, p = 0.904).Conclusions:⑴The combined loading regimen with clopidogrel plus aspirin can significantly reduce the rate of platelet aggregation in patients with clopidogrel resistance. Retrospective study confirmed that the short term (1-6months) incidence of major adverse cardiovascular events was significantly lower in the combined group as compared with the single group, particularly in reducing the rate of recurrent myocardial infarction, But there wasn't a significant difference in the incidence of major adverse cardiovascular events at the remaining periods within 2 years.⑵Sex, diabetes, hypertension, smoking, Previous PCI, clinical diagnosis and so on, except for age, were not found significantly difference on effectting the incidence of MACE and death at different time periods.⑶Age, LVEF, the days in hospital, No.of lesions per patient, No.of stents implanted per patient, No.of injuried vessels per patient were significant independent predictors of affectting the patients'all-cause mortality and major adverse cardiovascular events for coronary artery disease.⑷Subgroup analysis: for smoking, abnormal LDL patients, The choice of using a combined loading regimen can reduce the risk of major adverse cardiovascular events; for AMI, male, WBC count(>10×109/L) patients, Using the combined loading regimen can reduce the risk of TVR; for <65 years patients, Using the combined loading regimen can reduce the risk of death.
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