| Objective:To observe the prevalence and influential factors of clopidogrel resistance (CR) in patients with coronary heart disease (CHD). To analyse the relevance between CR and the prognosis.Subjects and Methods: From June 2010 to December 2010, total 128 patients with coronary heart disease who are identify diagnosed with coronary angiography in Meitan general hospitol ,China-Japan Friendship hospital and PLA(301) cardiovascular department, they were enrolled in the present study, and they received clopidogrel (75mg/d) and aspirin (100mg/d) after being in hospitals. All of the patients were measured the platelet aggregation (PA) induced by adenosine diphospate (ADP) that using light transmittance aggregometry twice before they had taken clopidogrel and 7 days later , then they were divided into two groups that clopidogrel resistance(CR) group and non-clopidogrel resistance group according to the difference between the basic platelet aggregation and the later one. Calculatting the prevalence of clopidogrel resistance (CR). Patients were selected randomly from all were measured the platelet aggregation (PA) using thrombelastogram(TEG) before they had taken clopidogrel 24 days. Compare with the PA between which were measured by light transmittance aggregometry and which were measured by TEG, to confirm the accuracy of the results further. Recording the base clinical characteriscts of all patients. Next morning hollow, testing routine blood, blood biochemical etc after being hospitalized. Analysising the differences between the clopidogrel resistance(CR) group and the non-clopidogrel resistance group about the clinical data. All patients follow-up three months for major adverse cardiac events(MACE).Results:1.There were 69 males and 59 females in the 128 patients whose average age is 62.84士11.17 years old. The group of Clopidogrel resistance (CR ) has 33 patients (25.78%), and the group of NCR has 95 (74.22%).The prevalence of clopidogrel resistance is 25.78% . The average age of CR's is 61.65士11.02 years old and there are 18 males(54.55%) and 15 females(45.45%).The average age of NCR's is 63.81±11.34 years old and there are 54 males(56.84%) and 41females(43.16%).There were no significant differences between the two groups.2 .There were 17 Diabetes of the group of CR , and the group of NCR is 29 .The prevalence of diabetes that the group of CR is higher than the group of NCR. There were significant differences between the two groups(P<0.05).3.In the group of CR, the number of patients who had a history of smoking are 9 ,and the number of patients who with hypertension are 23 , and the number of patients who with stroke are 3, and the number of patients who apply low molecular weight heparin are 16. In the group of NCR,the number of patients who had a history of smoking are 28 ,and the number of patients who with hypertension are 56, and the number of patients with stroke are 12, the number of patients who apply low molecular weight heparin are 57.There were no significant differences between the two groups. 4. There are 91 patients were performed PCI. The group ofclopidogrel resistance (CR ) has 28 patients .The prevalence of clopidogrel resistance is 30.77% . There are 37 patients were performed drug treatment. The group of clopidogrel resistance (CR ) has 5 patients .The prevalence of clopidogrel resistance is 13.51% .The prevalence of CR in the group of PCI is higher than the group of drug treatment.5.In the group of clopidogrel resistance (CR) there are 6 patients whoes age≥75 years old and the group of the NCR is 9.In the group of clopidogrel resistance (CR), there are 27 patients whoes age<75 years old and the group of the NCR is 86. Defined≥75 years old as an advanced age. Comparing the relevance between CR and the advanced age, there were no significant differences between the two groups(P>0.05).6.The rate of who placed 2 stents or more in clopidogrel resistance group(39.39%) was higher than non-clopidogrel resistance group(10.53%) ,There were significant differences(P<0.05) . In the CR group, the number of stents has the higher prevalence than NCR group. There were positive correlation between the prevalence of CR and stents number of CHD patients(CMH).7.There were no significant differences between the CR group and the NCR group in the level of myocardial ischemia (P>0.05).8.In the 29 patients who were measured the platelet aggregation (PA) using thrombelastogram(TEG) ,the number of CR group is 13 and the number of NCR group is 19. About the mean of platelet aggregation (PA) measured by thrombelastogram(TEG), the CR group is 73.25±14.41% and the NCR group is 61.17±10.39% . There were no significant differences between the two groups (P=0.063).9.There were significant differences between the two groups.in therapy methods,diabetes and stents numbers.10.There were 51 patients after three months follow-up on major adverse cardiac events(MACE). The CR group has 15 patients . and the NCR group has 36 patients. There were significant differences between the two groups at the rate of PCI again (P<0.05).There were no significant differences between the two groups at other cardiovascular events. Conclusion: 1.In the patients with coronary heart disease who are identify diagnosed with coronary angiography, the prevalence of clopidogrel resistance is 25.78% .2.The rate of DM in clopidogrel resistance group is higher than non-clopidogrel resistance group. 3.There were no significant differences between the two groups at had a history of smoking or with hypertension or with stroke or apply low molecular weight heparin .4.There was a higher prevalence of clopidogrel resistance in the patients who were performed PCI than Drug treatment. In the CR group, the more the number of stents the higher prevalence of CR. There were positive correlation between the prevalence of CR and stents number with CHD patients.5.There were no significant differences between the CR group and the NCR group in the level of myocardial ischemia and advanced age.6.There were no significant differences between the groups at the platelet aggregation (PA) by thrombelastogram(TEG).7.Clopidogrel resistance group has a high rate only at the rate of PCI again after 3-month follow-up. |
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