Clinical Features Of Clopidogrel Resistance In Patients With Acute Coronary Syndrome After PCI

Objective: To observe the clinical features of clopidogrel resistance inpatients withacute coronary syndrome after PCI and then analyze related factors which mayinfluence the appearance of the clopidogrel resistance.Methods:Elect187cases of patients from the department of Cardiology of FujianProvinceHospitalinjulytoDecember of2013who were diagnosed with acute coronary syndromeand received PCI successfully. According to platelet inhibition (ratio of platelet inhibition inducedby ADP in thromboelastogram), adopt the scheme of dual antiplatelet, and the patients weredivided into clopidogrel resistance group (inhibition ratio≤30%) and non-clopidogrel resistancegroup (inhibition ratio＞30%). Collect these patients’ clinical data, laboratory reports andsituations of PCI and then stats and analyze.Results:1. In those elected patients, the clopidogrel resistance group (CR group) was63cases (33.69%), the non-clopidogrel resistance group (NCR group) was124cases (66.31%).2. After comparing clinical data, the results of laboratory reports, the situations ofdrug use, coronary angiogram and situations of PCI, we found that comparing toNCR group, CR group had the statistical significance in the difference of BMI,percentage of patients with hypertension,percentage of patients withdiabetesmellitus, WBC, FBG, HbAlc, the ratio ofCYP2C19poor metabolismgenotype and the ratio of implanting2or more stents one time.3. Multi-factor binary logistic regression shows: diabetes mellitus（OR=3.225，95%CI：1.885~5.518， P=0.000）， high HbA1c （OR=5.680，95%CI：2.082~15.495，P=0.001），poor metabolism genotype（OR=3.955，95%CI：1.053~14.850，P=0.042），high WBC（OR=2.130，95%CI：1.032~4.304，P=0.036），hypertension（OR=2.452，95%CI：1.194~5.035，P=0.015）， implanting2or more stents（OR=1.706，95%CI：1.114~2.611，P=0.012），highBMI（OR=1.848，95%CI：1.022~3.341，P=0.040）may be independent riskfactors of the appearance of clopidogrel resistance.Conclusion:1. There exists clopidogrel resistance in ACS patients who have received PCI.What’s more, though DAPT was carried out, the ratio of clopidogrel resistance isrelatively high.2. High HbAlc level, diabetes mellitus, high BMI,hypertension,highWBC,CYP2C19poor metabolism genotype and implanting2or more stents maybe risk factors the appearance of clopidogrel resistance. So the useful methodswhich can prevent clopidogrel resistance are controlling weight, controllingblood pressure and blood glucose, improving insulin resistance，strengtheningantiplatelet therapy or useing other antiplatelet drugs for those patients who haveCYP2C19poor metabolism genotype and who have implanted2or more stents.