Background Despite outstanding antiplatelet properties of aspirin and clopidogrel, some patients taking these drugs continue to suffer complications. Antiplatelet resistance appears to be a new prognostic factor in ac...Background Despite outstanding antiplatelet properties of aspirin and clopidogrel, some patients taking these drugs continue to suffer complications. Antiplatelet resistance appears to be a new prognostic factor in acute coronary syndrome patients for clinical events associated with stent thrombosis （ST）. However, there is no optimal method to identify it and assess its correlation to clinical outcomes. This study sought to evaluate the predictive value of antiplatelet resistance assessed by whole blood impedance aggregometry for the risk of early ST in patients with acute coronary syndrome who underwent coronary stenting. Methods Platelet responses to aspirin and clopidogrel in 86 patients with acute coronary syndrome were measured by whole blood impedance aggregometry. Spontaneous platelet aggregation was defined as antiplatelet resistance identified by the increased electrical impedance. The clinical endpoint was early stent thrombosis during 30-day follow-up after coronary stenting. Results The prevalence of aspirin resistance, clopidogrel resistance and dual resistance of combined clopidogrel and aspirin resistance were 19.8%, 12.8% and 5.8% respectively. Diabetes, female and higher platelet counts were more frequently detected in clopidogrel-resistant and dual-resistant patients. During 30-day follow-up, the patients with clopidogrel resistance and dual resistance had higher incidence of early stent thrombosis （18.2% vs. 1.3%, 40.0% vs. 1.2%, P 〈0.05）. Binary Logistic Regression analysis indicated that dual resistance remained an independent predicator for early stent thrombosis （odds ratio 34.064, 95% CI 1.919-604.656, P=-0.016）. Conclusions Antiplatelet resistance assessed by whole blood impedance aggregometry is paralleled to clinical events, and dual antiplatelet resistance is an independent predicator for early stent thrombosis in patients with acute coronary syndrome. As a physiological assessment of platelet reactivity, whole blood impedance aggregometry is a convenient and accurate opt展开更多
Coronary stent fracture （SF） is a rare but potentially serious complication of coronary arterystenting. Here we report a case of acute myocardial infarction as a consequence of very late in-stent thrombosis due to m...Coronary stent fracture （SF） is a rare but potentially serious complication of coronary arterystenting. Here we report a case of acute myocardial infarction as a consequence of very late in-stent thrombosis due to multiple stent fractures at 8 sites and multiple stent malapposition formation four years after a sirolimus-eluting stent implantation （Firebird, Microport, Shanghai, China）.展开更多
目的：分析冠状动脉药物洗脱支架（drug-eluting stent， DES）置入术后支架内急性、亚急性血栓形成的原因及救治措施。方法回顾性分析2007-12～2012-12我院心脏内科冠心病患者行DES置入术后43例患者发生急性、亚急性血栓的时间、部位...目的：分析冠状动脉药物洗脱支架（drug-eluting stent， DES）置入术后支架内急性、亚急性血栓形成的原因及救治措施。方法回顾性分析2007-12～2012-12我院心脏内科冠心病患者行DES置入术后43例患者发生急性、亚急性血栓的时间、部位、因素及救治措施。结果①DES置入术5320例，术后发生支架内急性、亚急性血栓43例，发生率0．81％，死亡9例，死亡率20．93％。血栓形成时间0．25～11（4．2＆#177;4．6） d。②发生部位：左前降支33例，左回旋支3例，右冠状动脉7例；病变类型：B/C型39例， A型4例；发生血栓的血管直径：2．5 mm 19例，3．0 mm 22例，3．5 mm 2例。靶血管的支架数及长度：2枚以上38例，平均直径及总长度（2．87＆#177;0.40）mm ＆#215;（32．39＆#177;7．72）mm；1枚5例，平均（3．18＆#177;0．39）mm ＆#215;（19．87＆#177;4．66）mm。③原因：贴壁不良19例，小血管长病变14例，支架近远端过度扩张致内膜撕裂5例，氯吡格雷抵抗3例。④救治措施：采用直径略大的球囊高压扩张血栓部位35例，支架近远端再置入一枚支架5例。结论血栓形成主要与血管病变特点、球囊扩张后血管损伤程度、支架直径和长度、氯吡格雷抵抗等因素有关，多发生在糖尿病、高血压病、多支血管病变、前降支病变、弥漫复杂病变患者；急诊再次介入治疗是救治的首要措施。展开更多
文摘Background Despite outstanding antiplatelet properties of aspirin and clopidogrel, some patients taking these drugs continue to suffer complications. Antiplatelet resistance appears to be a new prognostic factor in acute coronary syndrome patients for clinical events associated with stent thrombosis （ST）. However, there is no optimal method to identify it and assess its correlation to clinical outcomes. This study sought to evaluate the predictive value of antiplatelet resistance assessed by whole blood impedance aggregometry for the risk of early ST in patients with acute coronary syndrome who underwent coronary stenting. Methods Platelet responses to aspirin and clopidogrel in 86 patients with acute coronary syndrome were measured by whole blood impedance aggregometry. Spontaneous platelet aggregation was defined as antiplatelet resistance identified by the increased electrical impedance. The clinical endpoint was early stent thrombosis during 30-day follow-up after coronary stenting. Results The prevalence of aspirin resistance, clopidogrel resistance and dual resistance of combined clopidogrel and aspirin resistance were 19.8%, 12.8% and 5.8% respectively. Diabetes, female and higher platelet counts were more frequently detected in clopidogrel-resistant and dual-resistant patients. During 30-day follow-up, the patients with clopidogrel resistance and dual resistance had higher incidence of early stent thrombosis （18.2% vs. 1.3%, 40.0% vs. 1.2%, P 〈0.05）. Binary Logistic Regression analysis indicated that dual resistance remained an independent predicator for early stent thrombosis （odds ratio 34.064, 95% CI 1.919-604.656, P=-0.016）. Conclusions Antiplatelet resistance assessed by whole blood impedance aggregometry is paralleled to clinical events, and dual antiplatelet resistance is an independent predicator for early stent thrombosis in patients with acute coronary syndrome. As a physiological assessment of platelet reactivity, whole blood impedance aggregometry is a convenient and accurate opt
文摘Coronary stent fracture （SF） is a rare but potentially serious complication of coronary arterystenting. Here we report a case of acute myocardial infarction as a consequence of very late in-stent thrombosis due to multiple stent fractures at 8 sites and multiple stent malapposition formation four years after a sirolimus-eluting stent implantation （Firebird, Microport, Shanghai, China）.
文摘目的：分析冠状动脉药物洗脱支架（drug-eluting stent， DES）置入术后支架内急性、亚急性血栓形成的原因及救治措施。方法回顾性分析2007-12～2012-12我院心脏内科冠心病患者行DES置入术后43例患者发生急性、亚急性血栓的时间、部位、因素及救治措施。结果①DES置入术5320例，术后发生支架内急性、亚急性血栓43例，发生率0．81％，死亡9例，死亡率20．93％。血栓形成时间0．25～11（4．2＆#177;4．6） d。②发生部位：左前降支33例，左回旋支3例，右冠状动脉7例；病变类型：B/C型39例， A型4例；发生血栓的血管直径：2．5 mm 19例，3．0 mm 22例，3．5 mm 2例。靶血管的支架数及长度：2枚以上38例，平均直径及总长度（2．87＆#177;0.40）mm ＆#215;（32．39＆#177;7．72）mm；1枚5例，平均（3．18＆#177;0．39）mm ＆#215;（19．87＆#177;4．66）mm。③原因：贴壁不良19例，小血管长病变14例，支架近远端过度扩张致内膜撕裂5例，氯吡格雷抵抗3例。④救治措施：采用直径略大的球囊高压扩张血栓部位35例，支架近远端再置入一枚支架5例。结论血栓形成主要与血管病变特点、球囊扩张后血管损伤程度、支架直径和长度、氯吡格雷抵抗等因素有关，多发生在糖尿病、高血压病、多支血管病变、前降支病变、弥漫复杂病变患者；急诊再次介入治疗是救治的首要措施。
