- 期刊
A HANC Risk Stratification Score for Antiplatelet Therapy Optimization with Low-Dose Prasugrel in Taiwanese Acute Coronary Syndrome Patients from the Switch Study
摘要
Background: A significant proportion of acute coronary syndrome (ACS) patients experience high on-treatment platelet reactivity (HPR) on clopidogrel-based dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). Objectives: This study assessed key independent risk factors associated with significant HPR risk on clopidogrel, but not prasugrel, in the Switch Study cohort of 200 Taiwanese ACS patients who switched from clopidogrel to low-dose prasugrel for maintenance DAPT after PCI. Methods: Univariate analysis and stepwise multivariate logistic regression analysis were conducted to identify key independent risk factors for HPR on clopidogrel, but not prasugrel. Results: A HANC [H: low hemoglobin (＜ 13 g/dL for men and ＜ 12 g/dL for women); A: age ≥ 65 years; N: non-ST elevation myocardial infarction; C: chronic kidney disease as defined by estimated glomerular filtration rate ＜ 60 mL/min] risk stratification score was developed, and demonstrated optimal sensitivity and specificity at a cutoff score of ≥ 2. The HANC score compared favorably against the recently validated ABCD score in the full Switch Study cohort (n = 200), and the ABCD-GENE score in a genotyped cohort (n = 102). Conclusions: The HANC score may serve to alert clinicians to patients at potentially higher HPR risk on clopidogrel, but not prasugrel. Further research to validate this score and assess its correlation with clinical outcomes is warranted.
延伸閱讀
- Chen, Y. C., Yeh, Y. C., & Chen, Y. Y. (2019). Physicians' Prescription Patterns of Antiplatelet Treatment as a Primary Prevention Strategy for Cardiovascular Disease Among Newly-Diagnosed Type 2 Diabetes Mellitus Patients in Taiwan: A Population-Based Study. The Changhua Journal of Medicine, 17(4), 148-165. https://doi.org/10.6501/CJM.201912_17(4).0002
- Li, Y. H., Fang, C. Y., Hsieh, I. C., Huang, W. C., Lin, T. H., Sung, S. H., Chiu, C. Z., Wu, C. J., Shyu, K. G., Chang, P. Y., Fang, C. C., Lu, T. M., Chen, C. P., Tai, W. C., Sheu, C. C., Wei, K. C., Huang, Y. H., Wu, H. M., & Hwang, J. J. (2018). 2018 Expert Consensus on the Management of Adverse Effects of Antiplatelet Therapy for Acute Coronary Syndrome in Taiwan. Acta Cardiologica Sinica, 34(3), 201-210. https://doi.org/10.6515/ACS.201805_34(3).20180302A
- Fan, C. M. (2015). Exploring the Association Between Disease-Specific Composite Process Scores and Patient Outcomes in Patients with Acute Myocardial Infarction in Taiwan [doctoral dissertation, National Taiwan University]. Airiti Library. https://doi.org/10.6342/NTU.2015.00548
- Shyu, K. G., Wu, C. J., Mar, G. Y., Hou, C. J. Y., Li, A. H., Wen, M. S., Lai, W. T., Lin, S. J., Kuo, C. T., Hwang, J. J., & Chiang, F. T. (2011). Clinical Characteristics, Management and In-Hospital Outcomes of Patients with Acute Coronary Syndrome-Observations from the Taiwan ACS Full Spectrum Registry. Acta Cardiologica Sinica, 27(3), 135-144. https://www.airitilibrary.com/Article/Detail?DocID=10116842-201109-201109300004-201109300004-135-144
- Hung, M. Y., Hung, M. J., Cheng, C. W., Yang, N. I., & Cherng, W. J. (2007). Safety and Predictors of a Positive Result of Intracoronary Ergonovine Testing in Patients with Ischemic Heart Disease without Hemodynamically Significant Coronary Artery Stenosis in Taiwan. Acta Cardiologica Sinica, 23(3), 150-159. https://www.airitilibrary.com/Article/Detail?DocID=10116842-200709-23-3-150-159-a