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Thromb Haemost 2019; 119(11): 1785-1794
DOI: 10.1055/s-0039-1695007
Cellular Haemostasis and Platelets
Georg Thieme Verlag KG Stuttgart · New York

Relationship of Platelet Reactivity and Inflammatory Markers to Recurrent Adverse Events in Patients with ST-Elevation Myocardial Infarction

Krishma Adatia  ‡
1   Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
,
Mohamed F. Farag‡
1   Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
2   Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom
,
Ying X. Gue
1   Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
2   Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom
,
Manivannan Srinivasan
1   Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
,
Diana A. Gorog
1   Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
2   Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom
3   Department of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
› Author Affiliations
Further Information

Publication History

26 April 2019

28 June 2019

Publication Date:
22 August 2019 (online)

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Abstract

Background Patients with ST-elevation myocardial infarction (STEMI) exhibit pro-thrombotic and pro-inflammatory states. Markers of enhanced platelet reactivity and inflammation are predictive of adverse outcome. However, the relationship between these biomarkers, and their combined usefulness for risk stratification, is not clear.

Methods In a prospective study of 541 patients presenting with STEMI, blood samples were taken on arrival to measure high-sensitivity C-reactive protein (hs-CRP), neutrophil/lymphocyte ratio (NLR) and platelet reactivity using the point-of-care Global Thrombosis Test. These biomarkers, alone and in combination, were related to the occurrence of major adverse cardiovascular events (MACE, defined as composite of cardiovascular death, myocardial infarction and cerebrovascular accident) at 30 days and 12 months.

Results Platelet reactivity and hs-CRP, but not NLR, were weakly predictive of MACE at 30 days and 12 months. The combination of enhanced platelet reactivity and raised hs-CRP was strongly predictive of MACE at 30 days (hazard ratio [HR] 3.46 [95% confidence interval [CI] 1.81–6.62], p < 0.001) and 12 months (HR 3.46 [95% CI 1.81–6.63], p < 0.001). Combination of all three biomarkers (NLR, hs-CRP and platelet reactivity) provided the best prediction of MACE at 30 days (HR 3.73 [95% CI 1.69–8.27], p < 0.001) and 12 months (HR 3.85 [95% CI 1.72–8.60], p < 0.001), and improved the prediction of MACE when added to Thrombolysis In Myocardial Infarction score (net reclassification index 0.296, p < 0.001).

Conclusion A combination of three easy to measure biomarkers on arrival, namely hs-CRP, NLR and platelet reactivity, can help identify STEMI patients at high risk of recurrent adverse events over the subsequent year.

Keywords

STEMI - neutrophil - lymphocyte - platelet reactivity - inflammation

* These authors contributed equally to the manuscript.


Supplementary Material

 

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