Related factors of clopidogrel resistance and its impact on prognosis in elderly patients with acute myocardial infarction
10.3969/j.issn.1009-0126.2025.01.013
- VernacularTitle:老年急性心肌梗死患者氯吡格雷抵抗的相关因素及其对预后的影响
- Author:
Lei SUN
1
;
Min XU
;
Shanshan CHEN
;
Chaojun WANG
Author Information
1. 230000 合肥,联勤保障部队第九○一医院院前急救科
- Publication Type:Journal Article
- Keywords:
myocardial infarction;
clopidogrel;
stents;
prognosis
- From:
Chinese Journal of Geriatric Heart Brain and Vessel Diseases
2025;27(1):57-62
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the risk factors of clopidogrel resistance in elderly patients with acute myocardial infarction(AMI)in order to provide personalized medication plans.Methods A prospective trial was conducted on 472 elderly AMI patients undergoing coronary stent placement in No.901 Hospital of Joint Logistics Support Force of PLA and Hangzhou Special Service Conva-lescent Center of Air Force from January 2018 to December 2022.All patients received clopidogrel for antiplatelet postoperatively,and after 7 consecutive days of administration,peripheral venous blood samples were collected to observe whether the patient had resistance to clopidogrel and to measure the concentration of active metabolites of clopidogrel and the maximum platelet aggrega-tion ratio(MARAA)of arachidonic acid induced platelets.According to MARAA,they were divid-ed into a clopidogrel resistant group(MARAA≥55％,142 cases)and a clopidogrel sensitive group of(＜55％,330 cases).The clinical characteristics were compared between the two groups,and multivariate logistic regression analysis was used to identify the risk factors for clopidogrel resistance.The impact of clopidogrel resistance on major adverse cardiovascular events was ana-lyzed.Results The clopidogrel resistant group had significantly higher MARAA level,decrease in the concentration of clopidogrel active metabolites,higher BMI,and larger ratios of obesity,CYP2C19*2 mutation,diabetes,hyperlipidemia and administration of hypoglycemic drugs when compared with the clopidogrel sensitive group(P＜0.01).Obesity,diabetes,hyperlipidemia and CYP2C19*2 mutation were risk factors for clopidogrel resistance in elderly AMI patients(OR=2.036,95％CI:1.282-3.235;OR=2.795,95％CI:1.803-4.334;OR=2.125,95％CI:1.355-3.331;OR=4.881,95％CI:2.807-8.486).The incidence of major adverse cardiovascular events was notably higher in the clopidogrel resistant group than the sensitive group(11.27％vs 4.55％,P＜0.01).After a prediction model was constructed with R4.0.3 statistical software,330 cases randomly selected from the dataset were assigned into a training set,and the remaining 142 cases into a validation set.The AUC value of the training set and the validation set was 0.750 and 0.780,respectively.Hosmer-Lemeshow Goodness of Fit test indicated that the model had good re-liability and predictive value(Chi-square=18.907,P=0.215).Conclusion Obesity,diabetes,hy-perlipidemia and CYP2C19*2 mutation are risk factors of clopidogrel resistance in elderly AMI patients,and clopidogrel resistance may lead to poor prognosis.
