Impact of Aspirin or Clopidogrel Resistance on Major Adverse Cardiovascular Events in Elderly Patients With Acute Coronary Syndrome / 中国循环杂志

ABSTRACT

Objective: To investigate the impact of clopidogrel or aspirin resistance on major adverse cardiovascular events (MACE) in elderly patients with acute coronary syndrome (ACS) and to explore the application value of thromboelastogram (TEG) in antiplatelet therapy. Methods: A total of 177 ACS patients admitted in our hospital from 2012-09 to 2014-12 were enrolled. The patients were at the mean age of (70.4±10.7) years, all of them received TEG and coagulation function test. Based on the reaction of antiplatelet therapy, they were divided into 2 groups Non-resistance group,n=98 and Resistance group,n=70, which was further divided into 2 subgroups as Maintenance dose subgroup,n=39 and Increased dose subgroup,n=40. The patients were followed-up for 3 months to observe MACE occurrence including cardiovascular death, angina recurrence, ischemic stroke, myocardial infarction, acute thrombosis and hemorrhage. Results: In Resistance group, there were 50/79 (63.3%) patients with aspirin resistance and 29 (36.7%) with clopidogrel resistance. Compared with Non-resistance group, Resistance group showed decreased coagulation time, clot formation time, TEG reducing rate after 30 minutes maximum amplitude (LY30), activated partial thrombin time (APTT), thrombin time (TT) and international normalized ratio (INR), allP<0.05; while increased levels angle, maximum amplitude of TEG, coagulationindex, ifbrinogen and D-dimer, allP<0.05. Compared with Non-resistance group, Resistance group had the higher MACE rate 21.5% vs 7.1%,P<0.05; in addition, Increased dose subgroup had the lower MACE rate than Maintenance dose subgroup 17.5 vs 25.6%,P<0.05. Conclusion: Clopidogrel or aspirin resistance had the higher incidence of MACE in elder ACS patients; TEG was helpful for guiding antiplatelet therapy and reducing MACE incidence.