Abstract：
BACKGROUND: Clopidogrel resistance (CR) is associated with adverse clinical outcomes in acute ischemic stroke or transient ischemic attack (TIA) patients. However, whether CR affects the long-term clinical prognosis remains to be clarified. The ABCD-GENE score is a novel risk model that identifies CR in cardiovascular disease patients; its diagnostic ability and application in ischemic stroke or TIA remain to be studied. This study aimed to investigate the diagnostic ability of the ABCD-GENE score for CR and analyze the relationship between CR and long-term clinical prognosis in patients with ischemic stroke or TIA.
METHODS: From January 2018 to January 2021, 251 ischemic stroke or TIA patients who were treated with clopidogrel for more than three months after onset and maintained the medication until the follow-up time were enrolled, and platelet reactivity was detected by thromboelastography. CYP2C19 gene analysis was performed. Adverse clinical outcomes were recorded from 3months after onset. The median follow-up time was 878days.
RESULTS: The prevalence of CR was 33.9%. The proportion of CYP2C19 loss-of-function carriers was 62.2%. The ABCD-GENE score≥10 was independently associated with CR (OR=1.82, 95% CI: 1.02-3.24, P=0.041), and the C-statistic value of the score (as a binary and integer variable) on CR was 0.58 and 0.63, respectively. The risk of long-term adverse clinical outcomes was not significantly different between CR and clopidogrel sensitive groups (12.94% vs. 11.44%, HR=1.22, 95% CI: 0.57-2.62, P=0.603). A similar result was observed between ABCD-GENE score≥10 and ABCD-GENE score<10 groups (10.38% vs. 12.64%, HR=1.19, 95% CI: 0.55-2.60, P=0.666).
CONCLUSIONS: In ischemic stroke or TIA patients, the ABCD-GENE score could identify the risk of CR. CR was not associated with long-term adverse clinical outcomes.
METHODS: From January 2018 to January 2021, 251 ischemic stroke or TIA patients who were treated with clopidogrel for more than three months after onset and maintained the medication until the follow-up time were enrolled, and platelet reactivity was detected by thromboelastography. CYP2C19 gene analysis was performed. Adverse clinical outcomes were recorded from 3months after onset. The median follow-up time was 878days.
RESULTS: The prevalence of CR was 33.9%. The proportion of CYP2C19 loss-of-function carriers was 62.2%. The ABCD-GENE score≥10 was independently associated with CR (OR=1.82, 95% CI: 1.02-3.24, P=0.041), and the C-statistic value of the score (as a binary and integer variable) on CR was 0.58 and 0.63, respectively. The risk of long-term adverse clinical outcomes was not significantly different between CR and clopidogrel sensitive groups (12.94% vs. 11.44%, HR=1.22, 95% CI: 0.57-2.62, P=0.603). A similar result was observed between ABCD-GENE score≥10 and ABCD-GENE score<10 groups (10.38% vs. 12.64%, HR=1.19, 95% CI: 0.55-2.60, P=0.666).
CONCLUSIONS: In ischemic stroke or TIA patients, the ABCD-GENE score could identify the risk of CR. CR was not associated with long-term adverse clinical outcomes.
摘要：
背景：氯吡格雷抵抗（CR）与急性缺血性卒中或短暂性脑缺血发作（TIA）患者的不良临床结局相关。然而,CR是否影响长期临床预后尚待澄清.ABCD-GENE评分是一种新的风险模型，可识别心血管疾病患者的CR；其诊断能力和在缺血性卒中或TIA中的应用仍有待研究。本研究旨在探讨ABCD-GENE评分对缺血性卒中或TIA患者CR的诊断能力,并分析CR与长期临床预后的关系。
方法：从2018年1月至2021年1月，纳入251例缺血性卒中或TIA患者，发病后使用氯吡格雷治疗超过3个月并维持药物治疗直至随访时间，血小板反应性通过血栓弹力图检测。进行CYP2C19基因分析。从发病后3个月开始记录不良临床结果。中位随访时间为878天。
结果：CR的患病率为33.9%。CYP2C19功能丧失携带者比例为62.2%。ABCD-GENE评分≥10与CR独立相关(OR=1.82,95%CI:1.02~3.24,P=0.041),CR评分的C统计值(作为二进制和整数变量)分别为0.58和0.63.CR和氯吡格雷敏感组之间的长期不良临床结局的风险没有显着差异（12.94％vs.11.44%，HR=1.22,95%CI:0.57-2.62,P=0.603)。在ABCD-GENE评分≥10组和ABCD-GENE评分<10组之间观察到类似的结果（10.38％vs.12.64%，HR=1.19,95%CI:0.55-2.60,P=0.666)。
结论：在缺血性卒中或TIA患者中，ABCD-GENE评分可以识别CR的风险。CR与长期不良临床结局无关。
方法：从2018年1月至2021年1月，纳入251例缺血性卒中或TIA患者，发病后使用氯吡格雷治疗超过3个月并维持药物治疗直至随访时间，血小板反应性通过血栓弹力图检测。进行CYP2C19基因分析。从发病后3个月开始记录不良临床结果。中位随访时间为878天。
结果：CR的患病率为33.9%。CYP2C19功能丧失携带者比例为62.2%。ABCD-GENE评分≥10与CR独立相关(OR=1.82,95%CI:1.02~3.24,P=0.041),CR评分的C统计值(作为二进制和整数变量)分别为0.58和0.63.CR和氯吡格雷敏感组之间的长期不良临床结局的风险没有显着差异（12.94％vs.11.44%，HR=1.22,95%CI:0.57-2.62,P=0.603)。在ABCD-GENE评分≥10组和ABCD-GENE评分<10组之间观察到类似的结果（10.38％vs.12.64%，HR=1.19,95%CI:0.55-2.60,P=0.666)。
结论：在缺血性卒中或TIA患者中，ABCD-GENE评分可以识别CR的风险。CR与长期不良临床结局无关。
