Thromb Haemost 2017; 117(05): 923-933
DOI: 10.1160/TH16-10-0785
Cellular Haemostasis and Platelets
Schattauer GmbH

Platelet turnover predicts outcome after coronary intervention

Matthias K. Freynhofer
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
,
Liana Iliev
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
,
Veronika Bruno
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
3   Department of Obstetrics and Gynecology, Wilhelminenhospital, Vienna, Austria
,
Miklos Rohla
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
,
Florian Egger
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
,
Thomas W. Weiss
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
6   Medical Faculty, Sigmund Freud University, Vienna, Austria
,
Wolfgang Hübl
4   Department of Laboratory Medicine, Wilhelminenhospital, Vienna, Austria
,
Martin Willheim
4   Department of Laboratory Medicine, Wilhelminenhospital, Vienna, Austria
,
Johann Wojta
2   Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
5   Department of Cardiology, Medical University of Vienna, Vienna, Austria
,
Kurt Huber
1   3rd Medical Department, Cardiology, Wilhelminenhospital, Vienna, Austria
6   Medical Faculty, Sigmund Freud University, Vienna, Austria
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Publikationsverlauf

Received: 18. Oktober 2016

Accepted after major revision: 25. Januar 2017

Publikationsdatum:
28. November 2017 (online)

Summary

Elevated platelet turnover contributes to high platelet reactivity. High platelet reactivity after percutaneous coronary intervention (PCI) is associated with major adverse cardiovascular events (MACE). The purpose of this study was to determine the prognostic value of platelet turnover and function with regard to MACE after PCI with stent implantation. In this prospective observational study, 486 consecutive patients after PCI on aspirin and clopidogrel were included to determine platelet turnover (mean platelet volume (MPV), reticulated platelet fraction (RPF)) and platelet function (multiple electrode aggregometry (MEA), vasodilator-stimulated phosphoprotein-phosphorylation (VASP-P) assay). At six-months follow-up, MACE occurred in 10.7 % of patients. RPF (odds ratio [OR]=1.173 (95% confidence interval [CI 95 %] 1.040–1.324), p=0.009) and MPV (OR=1.459 (CI 95 % 1.059–2.008), p=0.021) were univariable predictors of MACE, whereas VASP-P (OR=1.016 (CI 95 % 1.000–1.032), p=0.052) and MEA (OR=0.999 (CI 95 % 0.980–1.017), p=0.895) failed to predict MACE. RPF remained the only platelet variable independently associated with MACE. The best model to predict MACE included: troponin I (OR=1.007 (CI 95 % 1.002–1.012), p=0.009), RPF (OR=1.136 (CI 95 % 1.001–1.288), p=0.048), CRP (OR=1.008 (CI 95 % 1.001–1.014), p=0.023) and history of myocardial infarction (OR=2.039 (CI 95 % 1.093–3.806), p=0.025). RPF (OR=1.211 (CI 95 % 1.042–1.406), p=0.012) was also independently associated with in-hospital bleedings. In conclusion, RPF as index of platelet turnover is an independent predictor of MACE and bleeding events in PCI patients on dual antiplatelet therapy. Since RPF can reliably be quantified along with routine haemograms, RPF might easily be applied in the setting of cardiovascular risk prediction.

 
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