Translated Abstract
Backgroud:
For the past few years,clopidogrel,a drug can inhibit platelet aggregation and prevent thrombogenesis,is used for therapy of Acute Coronary Syndrome(ACS).Nevertheless,there is a different between therapeutic effect of clopidogrel in different patients which is relative to drug interaction and gene polymorphism.Calcium channel blocker (CCB) is widely used to treat cardiac diseases，such as hypertension and angina. Due to CCB and clopidogrel which are metabolized by cytochrome p450 at the same time, several clinical researches indicated that CCB effected antiplatelet function of clopidogrel.There are existed many disputes on this clinical question.
Obective:
This clinical research aimed at observing the influential of CCB to clopidogrel by examining plasma P-selection and CD63 level in ACS of hypertension.
Methods:
It included 90 patients with ACS of hypertension who were treated during the May of 2013 and January of 2014 period in cardiovascular medicine of the second affiliated hospital of xi‘an jiaotong university.They were divided into two groups that one group(experiment group) lowered blood pressure by CCB,another(control group) by ACEI or ARB. All patients were treated with clopidogrel and aspirin to inhibited platelet aggregation .Two groups were phlebotomized at the first day and the seventh day in the hospital which were used to examine plasma P-selection and CD63 level by Enzyme-Linked Immuno Sorbent Assay (ELISA).some information were recorded to calculate GRACE risk score，including Age,heart rate,systolic blood pressure (SBP),Killip classification,serum creatinine,cardiac arrest（with or without ）,the changing of myocardial enzymes and electrocardiogram.
Results:
1. The baseline clinical characteristics did not differ among 2 groups(P＞0.05).
2. The concentration of P-selection in the experiment group and the control group before treatment were (51.24±15.25)ug/L and (52.44±17.82)ug/L.The difference among two groups were not significant(P=0.735).The level of P-selection in the two groups after treatment were (44.93±14.30)ug/L and (45.67±13.89)ug/L.There were no difference between two groups(P=0.805).The concentration of CD63 in two groups before treatment were (59.44±16.07)U/ml and (60.31±19.94)U/ml.The differences among two group were not significant(P=0.822).The level of CD63 in the two groups after treatment were (48.76±16.77)U/ml and（49.11±16.41)U/ml. There were no difference between two groups (P=0.920).
3. Compared with the treatment before,P-selection and CD63 of plasma were significantly lower after treatment (P＜0.05).
4. Follow-up observation for three mouths,there were no difference between two groups about major adverse cardiac events(P＞0.05).
5. There was a positive correlation between P-selection and CD63 Correlation Coefficient was 0.70（before treatment）and 0.50（ after treatment）,P＜0.05.
6. There was a positive correlation between P-selection and GRACE (R=0.43,P＜0.05), CD63 and GRACE(R=0.39,P＜0.05).
7. All patients were divided into UA group、NSTEMI group and STEMI group according to diagnosis. Compared plasma P-selection and CD63 in three groups of patients by one-way analysis of variance was to confirm whether there was a difference . Results show：the P selection and CD63 of UA group was clearly lower than the NSTEMI and STEMI group（P＜0.05）. The P selection and CD63 between NSTEMI and STEMI group had no significant difference (P＞0.05).
8. GRACE was positively correlated with the severity of coronary stenosis and lesion count. Compared with patients who had moderate or severe stenosis, there were more patients with mild narrowing of coronary in low-risk group of GRACE（P＜0.05）. High-risk group of GRACE had more patients with severe stenosis than mild narrowing of coronary（P＜0.05）.The patients who were in low-risk group of GRACE got more single vessel disease than double or triple-vessel disease（P＜0.05）.High-risk group of GRACE had less patients with single and double-vessel disease（P＜0.05）.
Conclusion:
1. There was no evidence that CCB decreased the efficacy of clopidogrel in patients with ACS of hypertension. The major adverse cardiac events in two groups had no significant difference with 3 months.
2. There was a positive correlation between P-selection and CD63 .It could be used for assessment of Platelet activation and its function.
3. GRACE was positively correlated with the severity of coronary stenosis and lesion count, indicated that the GRACE to determine the severity of coronary artery disease had a certain reference value which was better for clinician to estimate state of an illness with ACS quickly and accurately.
4. P-selectin, CD63 were positively correlated with GRACE,suggested that P-selectin, CD63 could be used for a preliminary assessment of the condition of patients with ACS.
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