title: Relationship between hyporesponsiveness to clopidogrel measured by thrombelastography and in stent restenosis in patients undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  The relationship between hyporesponsiveness to clopidogrel and in stent restenosis (ISR) was analyzed, and the cut-off value of hyporesponsiveness to clopidogrel for ISR was evaluated.
  
  
  METHODS
  861 consecutive patients enrolled and patients' inhibition rates in arachidonic acid (AA) and adenosine 5'-diphosphate (ADP) pathways were measured by thrombelastography (TEG) system. Patients were divided into ISR and non-ISR groups according to the results of coronary angiography. Correlation between hyporesponsiveness to clopidogrel and ISR was analyzed.
  
  
  RESULTS
  249 patients were in ISR group and 612 patients were in non-ISR group. The frequency of clopidogrel hyporesponsiveness in ISR group was significantly higher than that in non-ISR group (P<0.01). Inhibition rates in AA and ADP pathways in ISR group were lower than those in non-ISR group (P<0.01). The inhibition rate in ADP pathway was inversely correlated with (r=-0.225, P=0.001) the severity of ISR. After being adjusted for traditional covariates, the inhibition rate in ADP pathway (β=-0.191, R(2)=0.011, P=0.013) remained independently associated with the severity of ISR; clopidogrel hyporesponsiveness was an independent risk factor of ISR (HR 6.62, 95% CI 2.84-15.49, P=0.001). ROC curve analysis showed that the predictive cut-off value of the inhibition rate in ADP pathway for ISR was 10.1%.
  
  
  CONCLUSIONS
  The inhibition rate in ADP pathway is inversely related to the ISR severity. Clopidogrel hyporesponsiveness is an independent risk factor for ISR and can predict the risk of ISR.
authors.affiliation: Department of Cardiology, Hainai Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan, People's Republic of China; Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors.forename: Zhenhong
authors.initials: Z
authors.lastname: Fu
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Cardiology, Hainai Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan, People's Republic of China.
authors.forename: Mingzhi
authors.initials: M
authors.lastname: Shen
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China. Electronic address: xuehao301@hotmail.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Xue
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Jing
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
authors.forename: Xia
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China. Electronic address: chenyundai301@gmail.com.
authors.forename: Yundai
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000077144:Clopidogrel; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors; D013916:Thrombelastography / Q000379:methods*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Antiplatelet agents; Hyporesponsiveness to clopidogrel; In stent restenosis; Percutaneous coronary intervention; Thrombelastography