Impact of clopidogrel resistance on no-reflow in patients with acute myocardial infarction during primary percutaneous coronary intervention

QIN Xiu-chuan; WANG Chun-mei; ZHU Xiao-ling

doi:10.3760/cma.j.issn.1673-4777.2013.05.012

Abstract：Objective To evaluate clopidogrel resistance in patients who underwent primary percutaneous coronary intervention (PPCI) and the relationship with the no-reflow phenomenon.Methods From January 2009 to December 2011,765 acute myocardial infarction patients undergoing PPCI were enrolled in this study.Clopidogrel resistance defined according to ADP induced maximal platelet aggregation rate; the patients were divided into no reflow group and control group.The clinical data were compared to analyze the clopidogrel resistance contributing to no reflow.Results Male,the history of hypertension,smoking,time to admission,the count of platelet and white blood cell,IRA,stent diameter and door-balloon time showed no differences between two groups.Compared with the control group,age(62 ± 10 vs 60 ± 11,P =0.032),diabetes mellitus [29.6％ (24/81) vs 19.9％ (136/684),P =0.044],the occurrence of clopidogrel resistance[38.3％ (31/81) vs 24.9％ (170/684),P =0.011],thrombolysis in myocardial infarction flow grade 0 pre-procedure [82.7 ％ (67/81) vs 70.5 ％ (482/684),P =0.026],using of tirofiban [42.0％ (34/81) vs 30.8 ％ (211/684),P =0.045],the peak of cardial troponin Ⅰ [(58 ± 14)μg/L vs (54±13) μg/L,P=0.015],creatine kinase isoenzyme [(156 ±42)U/L vs (145 ±40) U/L,P=0.027] and creatine kinase [(1437 ±202) U/L vs(1388 ±216) U/L,P =0.041] and mortality[4.9％ (4/81)vs 1.0 ％ (7/684),P =0.022] were increased significantly; the incidence of ST resolution [66.7％ (54/81) vs 82.5％(564/684),P=0.001] and left ejection fraction [(48 ±11)％ vs (51 ±11)％,P=0.028]were decreased in no-roflow group.Logistic analysis showed that clopidogrel resistance was an independent factor of no-reflow during PPCI.Conclusion Clopidogrel resistance may be one of the responsible mechanisms for the no-reflow phenomenon.