Establishment of A Nomogram to Assess the Risk of High On-treatment Platelet Reaction After Taking Clopidogrel After PCI

OBJECTIVE To construct a nomogram model that can assess the risk of high on-treatment platelet reaction (HTPR) after taking clopidogrel after percutaneous coronary intervention(PCI). METHODS The patients with coronary atherosclerotic heart disease who were hospitalized in the department of cardiovascular medicine and PCI in Lu’an Hospital Affiliated to Anhui Medical University between January and October 2020 were selected as the research objects. The cluster sampling method was used to divide the patients into modeling set(n=223) and validation set(n=61), analyze the clinical data of patients in the modeling set, use single factor and logistic regression to analyze the risk factors of clopidogrel HTPR, and establish related nomograms forecast model. RESULTS Diabetes, homocysteine≥ 15 μmol·L^-1, hypersensitivity C-reactive protein≥ 3.0 mg·L^-1, multivessel disease and carrying CYP2C19^*2 were independent risk factors for HTPR after taking clopidogrel after PCI(^P<0.05). Based on the above risk factors, a nomogram model was established to predict the occurrence of HTPR after taking clopidogrel after PCI, and the model was verified. The results showed that the C-index of the modeling set and the validation set were 0.814(95%CI: 0.732-0.846) and 0.778(95%CI: 0.741-0.802), respectively. The calibration curve fitted well with the standard curve, and the AUC of ROC curve was 0.845 and 0.774, respectively, indicating that the nomogram model had good predictive ability. CONCLUSION There are many risk factors that cause HTPR after taking clopidogrel after PCI. The nomogram model established in this study based on risk factors has good predictive ability and can provide reference for clinical screening for high-risk patients and optimization of antithrombotic drug treatment plans.