Renal function assessed using cystatin C and antiplatelet efficacy of clopidogrel assessed using the vasodilator-stimulated phosphoprotein index in patients having percutaneous coronary intervention
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu srovnávací studie, časopisecké články, práce podpořená grantem
PubMed
22154314
DOI
10.1016/j.amjcard.2011.10.019
PII: S0002-9149(11)03193-6
Knihovny.cz E-zdroje
- MeSH
- balónková koronární angioplastika metody MeSH
- cystatin C krev MeSH
- fosfoproteiny krev MeSH
- hodnoty glomerulární filtrace účinky léků fyziologie MeSH
- imunoanalýza MeSH
- inhibitory agregace trombocytů aplikace a dávkování MeSH
- klopidogrel MeSH
- koronární trombóza krev patofyziologie prevence a kontrola MeSH
- krevní proteiny MeSH
- lidé MeSH
- mikrofilamentové proteiny krev MeSH
- molekuly buněčné adheze krev MeSH
- následné studie MeSH
- nemoci koronárních tepen patofyziologie terapie MeSH
- prognóza MeSH
- senioři MeSH
- stenty MeSH
- tiklopidin aplikace a dávkování analogy a deriváty MeSH
- vyšetření funkce ledvin MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Názvy látek
- cystatin C MeSH
- fosfoproteiny MeSH
- inhibitory agregace trombocytů MeSH
- klopidogrel MeSH
- krevní proteiny MeSH
- mikrofilamentové proteiny MeSH
- molekuly buněčné adheze MeSH
- tiklopidin MeSH
- Vasodilator-Stimulated Phosphoprotein MeSH
Renal dysfunction is a strong independent predictor of stent thrombosis. The aim of the present study was to evaluate the strength and direction of the association between kidney function and clopidogrel efficacy. The study group consisted of consecutive patients (n = 275) who underwent stent implantation. Drug efficacy was measured using the vasodilator-stimulated phosphoprotein (VASP) index 20 ± 4 hours after clopidogrel 600 mg. Nonresponse was defined as an VASP index ≥50%. Renal function was determined using serum cystatin C. The upper reference levels are 1.12 mg/L for ≤65 years of age and 1.21 mg/L for >65 years of age. Estimated glomerular filtration was calculated using cystatin C. The median value of cystatin C was 1.16 mg/L (twenty-fifth and seventy-fifth percentiles 0.96 and 1.43); 47.63% of the study population had cystatin C above reference levels and 33.1% of patients were nonresponders to clopidogrel. No correlation was found between clopidogrel efficacy assessed with the VASP index and kidney function assessed with cystatin C (Spearman r = -0.070, p = 0.248). Based on cystatin C the proportion of nonresponders to clopidogrel was 34.4% versus 31.9% (p = 0.702) in patients with impaired renal function compared to normal renal function, respectively. The proportion of clopidogrel nonresponders did not differ (p = 0.902) among groups with normal (28.8%), mildly impaired (34.8%), moderately impaired (32.9%), and severely impaired (34.8%) renal function. In conclusion, renal function assessed by cystatin C does not predict clopidogrel efficacy. Renal dysfunction is a complex entity and its significant relation to stent thrombosis cannot be explained simply by a decrease in clopidogrel efficacy.
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