Abstract:

Objective To observe the influential factors of clopidogrel resistance in patients with coronary heart disease treated with aspirin and clopidogrel after percutaneous coronary intervention (PCI). Methods A total of 181 patients with coronary heart disease treated with aspirin and clopidogrel after PCI were enrolled, and were examined with fasting thrombelastography 3 d after PCT. Patients were divided into clopidogrel resistance group and clopidogrel sensitive group according to adenosine diphosphate-induced platelet aggregation inhibition rate. The general clinical data, biochemical parameters and imaging characteristics were compared between two groups, and the independent risk factors of clopidogrel resistance were explored by Logistic regression analysis. Results The incidence of clopidogrel resistance after PCI was 33.1%(60/181) in these 181 patients. There were significant differences in gender ratio, history of smoking, history of diabetes, fasting plasma glucose, glycosylated hemoglobin, triglyceride and cardiac troponin (cTnⅠ) between two groups (P<0.05), and there was no significant difference in the imaging characteristics between two groups （P>0.05）. Logistic regression analysis revealed that female (P=0.004, OR= 3.411，95%CI=1.466-7.940), history of smoking (P=0.033, OR=4.930, 95%CI=1.137-21.371）, history of diabetes (P=0.007, OR=3.226, 95%CI=1.378-7.551）, higher fasting plasma glucose （P=0.028，OR=2.113, 95%CI=1.082-4.125）, higher glycosylated hemoglobin （P=0.000, OR=3.744，95%CI=1.868-7.505）, higher triglyceride （P=0.019, OR=2.639, 95%CI=1.173-5.937） and higher cTnⅠ（P=0.000, OR=5.631, 95%CI=2.942-10.777）were independent risk factors of clopidogrel resistance. Conclusion Female gender, diabetes, smoking, high blood lipids and myocardial enzyme elevation might be risk factors of clopidogrel resistance in patients with coronary heart disease after PCI.

Key words: thrombelastography, clopidogrel, platelet aggregation inhibition rate, stenting