Portal de Periódicos da CAPES

Platelet Distribution Width on Admission Predicts In-Stent Restenosis in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus Treated with Percutaneous Coronary Intervention

2018; Lippincott Williams & Wilkins; Volume: 131; Issue: 7 Linguagem: Inglês

10.4103/0366-6999.228247

2542-5641

Chengping Hu, Yu Du, Yong Zhu, Chao Shi, Zheng Qin, Yingxin Zhao,

Acute Myocardial Infarction Research

It is known that there is a definite association between platelet distribution width (PDW) and poor prognosis in patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). However, there are no data available regarding the prognostic significance of PDW for in-stent restenosis (ISR) in patients with CAD and T2DM. We aimed to determine the value of PDW on admission that predicted ISR in patients with CAD and T2DM.Between January 2012 and December 2013, a total of 5232 consecutive patients diagnosed with CAD and T2DM undergoing percutaneous coronary intervention were admitted. Three years of retrospective follow-up was undertaken. A total of 438 patients with second angiography operations were included. ISR was defined as ≥50% luminal stenosis of the stent or peri-stent segments. Continuous data were presented as the mean ± standard deviation or median (P25, P75) and were compared by one-way analysis of variance or Kruskal-Wallis H-test. Categorical variables were presented as percentages and were compared by Chi-square test or Fisher's exact test. The association between PDW and ISR was calculated by logistic regression analysis. A two-sided value of P < 0.05 was considered statistically significant. Statistical analyses were performed by SPSS version 22.0 for windows.Fifty-nine patients with ISR, accounting for 13.5% of the total, were included. ISR was significantly more frequent in patients with higher PDW quartiles compared with lower quartiles. We observed that PDW had a strong relationship with mean platelet volume (r = 0.647, 95% confidence interval [CI]: 0.535-0.750, P < 0.0001). The receiver-operating characteristic curves showed that the PDW cutoff value for predicting ISR rate was 13.65 fl with sensitivity of 59.3% and specificity of 72.4% (area under curve [AUC] = 0.701, 95% CI: 0.625-0.777, P < 0.001). Multivariate analysis showed that the risk of ISR increased approximately 30% when PDW increased one unit (odds ratio [OR]: 1.289, 95% CI: 1.110-1.498, P = 0.001). Patients with higher PDW, defined as more than 13.65 fl, had a 4-fold higher risk of ISR compared with lower PDW (OR: 4.241, 95% CI: 1.879-9.572, P = 0.001). Furthermore, when patients were divided by PDW quartiles values, PDW was able to predict ISR (Q2: OR = 0.762, 95% CI: 0.189-3.062, P = 0.762; Q3: OR = 2.782, 95% CI: 0.865-8.954, P = 0.086; and Q4: OR = 3.849, 95% CI: 1.225-12.097, P = 0.021, respectively; P for trend <0.0001).PDW is an independent predictor of ISR in patients with CAD and T2DM.冠心病合并2型糖尿病患者经皮冠脉支架术后血小板分布宽度与支架内再狭窄的关系摘要背景：既往研究表明血小板分布宽度（PDW）与冠心病（CAD）患者预后关系密切。但PDW预测支架内再狭窄（ISR）的价值尚未得到充分研究。本研究目的在于探讨PDW与CAD合并2型糖尿病（T2DM）患者经皮冠脉介入支架术（PCI）后支架内再狭窄的关系。 方法：收集2012年1月至2013年12月于中国北京安贞医院住院的冠心病合并2型糖尿病并于我院行经皮冠脉介入支架术的5232名患者。回顾分析入选患者其后3年我院的就诊资料，最终438名再次于我院行经皮冠脉造影的患者纳入本研究。支架内再狭窄定义为造影发现支架内及支架旁5mm内不少于50%管腔丢失。采用SPSS22.0统计软件进行数据处理。符合正态分布的计量资料采用平均值±标准差描述, 组间比较采用单因素方差分析；不符合正态分布的计量资料采用中位数（P25，P75）描述，组间比较采用非参数检验；计数资料组间比较采用2检验。受试者工作特征曲线(ROC)分析预测ISR事件最佳的PDW值，并作为高PDW的定义标准。将对PDW以及ISR具有明显影响和单因素分析中P值＜0.1的变量放入Logistic回归模型，以向后逐步选择法作为自变量筛选方法，研究分析PDW与ISR的关系。双侧P＜0.05为差异有统计学意义。 结果：438名患者中59名（13.5%）发生ISR。患者基线资料通过PDW四分位分组比较发现PDW高四分位组患者ISR发生风险显著高于低四分位组。线性相关分析发现PDW与ISR密切相关( r=0.647, 95%置信区间［CI］: 0.535-0.750, P＜0.0001)。ROC曲线显示PDW以13.65fl预测ISR的敏感度以及特异度分别为59.3%、72.4%（曲线下面积［AUC］= 0.701, 95% CI：0.625-0.777, P＜0.001）。 多因素分析发现PDW每升高1个单位，ISR发生风险增加约30%(比值比 [OR]:1.289, 95% CI: 1.110-1.498, P=0.001)，高PDW（定义为PDW≥13.65fl）患者ISR发生风险是低PDW的4倍(OR:4.241, 95% CI: 1.879-9.572, P=0.001)。将PDW四分位分组后变量放入Logistic回归，分析发现ISR风险随四分位PDW组升高而逐渐升高（Q2: OR=0.762, 95%CI 0.189-3.062, P=0.762，Q3:OR=2.782, 95%CI 0.865-8.954, P=0.086, Q4: OR=3.849, 95%CI 1.225-12.097, P =0.021; P for trend<0.0001）。 结论：PDW是冠心病合并2型糖尿病患者PCI术后ISR的独立危险因素。.