rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2008-4-2-23-29rpcardio-1076Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯANTIPLATELET THERAPY RESISTANCE IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST-SEGMENT ELEVATIONРЕЗИСТЕНТНОСТЬ К АНТИТРОМБОЦИТАРНЫМ ПРЕПАРАТАМ У БОЛЬНЫХ ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ С ПОДЪЕМОМ СЕГМЕНТА STАйнетдиноваД. Х.AinetdinovaD. H.

Кафедра факультетской терапии №1

Department of faculty therapy №1

УдовиченкоА. Е.UdovichenkoA. Е.

Кафедра факультетской терапии №1

Department of faculty therapy №1

СулимовВ. А.SulimovV. A.

Кафедра факультетской терапии №1

Department of faculty therapy №1

Московская медицинская академия им. И.М. СеченоваРоссияMoscow Medical Academy named after I.M. SetchenovRussian Federation200827012016422329Copyright © Ainetdinova D.H., Udovichenko A.Е., Sulimov V.A., 20162016Айнетдинова Д.Х., Удовиченко А.Е., Сулимов В.А.Ainetdinova D.H., Udovichenko A.Е., Sulimov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1076Aim

Aim. To evaluate the incidence of acetylsalicylic acid (ASA) and clopidogrel resistance in patients with acute coronary syndrome with ST-segment elevation and to find out possible clinical factors, contributing to this state.

Material and methods

Material and methods. 58 patients with acute coronary syndrome with ST-segment elevation (49 men, 9 women) were included into the study. Age of patients ranged from 37 tо 84 y.o. (60,8±12,3 y.o. in average). Platelet aggregation was assessed by the Born’s method. Level of arachidonic acidinduced aggregation ≥20% considered as ASA resistance. Decreasing of ADP-induced platelet aggregation ≥20% considered as ASA resistance. Decreasing of ADP-induced platelet aggregation <10%, 10-29%, and ≥30% compared to the basal level considered as clopidogrel resistance, “partial clopidogrel resistance” or clopidogrel sensitiveness, respectively.

Results

Results. ASA and clopidogrel decreased arachidonic acid-induced and ADP-induced aggregation after 7 days of the therapy compared to the basal levels (р<0,05). The highest incidence of resistance was registered in patients with diabetes mellitus (71,1% to ASA, 57,1% to clopidogrel) and obe-sity (42,9% to clopidogrel).

Conclusion

Conclusion. The incidence of ASA and clopidogrel resistance reached to 28,9% and 24,4% respectively in patients with acute coronary syndrome with ST-segment elevation. The prevalence of antiplatelet therapy resistance is significantly higher in patients with diabetes mellitus and obesity (р<0,05). The incidence of early complications of acute myocardial infarction is higher in patients resistant to ASA and clopidogrel.

Цель

Цель. Оценить частоту резистентности к ацетилсалициловой кислоте (АСК) и клопидогрелю у больных острым коронарным синдромом (ОКС) с подъемом сегмента ST и выявить возможные клинические факторы, способствующие развитию данного состояния.

Материал и методы

Материал и методы. В исследование включены 58 больных (49 мужчин, 9 женщин) в возрасте от 37 до 84 лет (в среднем 60,8±12,3 лет) с острым коронарным синдром с подъемом сегмента ST. Агрегацию тромбоцитов исследовали методом Борна. Критерием резистентности к АСК являлся уровень агрегации ≥20% после индукции арахидоновой кислотой. При снижении АДФ-индуцированной агрегации тромбоцитов <10%, 10-29%, и ≥30% относительно исходного уровня пациентов рассматривали как резистентных, «частично резистентных» и чувствительных к терапии клопидогрелем, соответственно.

Результаты

Результаты. АСК и клопидогрель вызывали значимое снижение агрегации, индуцированной арахидоновой кислотой и АДФ, к 7 дню лече-ния (р<0,05). Наиболее высокая частота резистентности выявлена у больных сахарным диабетом (71,1% к АСК и 57,1% к клопидогрелю) и ожирением (42,9% к клопидогрелю).

Заключение

Заключение. Среди больных ОКС с подъемом сегмента ST частота резистентности достигает 28,9% к АСК и 24,4% к клопидогрелю. У боль-ных сахарным диабетом, ожирением частота резистентности достоверно выше (р<0,05). У резистентных к АСК и клопидогрелю больных до-стоверно выше частота ранних осложнений инфаркта миокарда.

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The authors declare that there are no conflicts of interest present.