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Published on: January 28, 2020
Platelet activation predicts recurrent ischemic events after percutaneous coronary angioplasty: a 6 months
Jacopo Gianetti1, Maria Serena Parri, Silverio Sbrana
1Laboratory of Atherosclerosis and Thrombosis, CNR Institute of Clinical Physiology, G Pasquinucci Hospital, Massa, Italy. gianetti@ifc.pi.cnr.it
Insights
Platelet reactivity, measured by collagen-epinephrine (CEPI) and collagen-ADP (CADP) closure times using the PFA-100, predicts recurrent coronary events after percutaneous coronary intervention (PCI). Enhanced platelet function indicates a higher risk of clinical recurrence.
Area of Science:
- Cardiology
- Hematology
- Medical Diagnostics
Background:
- Platelet reactivity despite anti-thrombotic therapy is a risk factor for recurrent myocardial ischemia in coronary artery disease patients.
- Enhanced platelet function may predict coronary events post-percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate if collagen-epinephrine (CEPI) and collagen-ADP (CADP) closure times, measured by Platelet Function Analyzer (PFA-100), predict recurrent coronary events after PCI.
- To assess the role of platelet function in risk stratification for patients undergoing PCI.
Main Methods:
- 175 patients (stable angina or acute coronary syndromes) underwent CEPI and CADP-CT measurements 30+/-8 hours post-PCI.
- Patients were stratified by CEPI-CT (
190 s) and CADP-CT quartiles. - Follow-up was conducted for a mean of 6 months.
Main Results:
- CEPI-CT < 190 s and CADP-CT < 82 s were associated with significantly higher rates of clinical recurrence.
- Multivariate analysis confirmed that the lowest CADP-CT quartile (HR 36.5, p<0.01) and CEPI-CT < 190 s (HR 6.7, p=0.01) independently predicted recurrent coronary events.
- These findings highlight the predictive value of platelet function tests.
Conclusions:
- Enhanced platelet function, measured by PFA-100 under high shear rates, is an independent predictor of adverse clinical outcomes after PCI.
- PFA-100 testing can aid in risk stratification for patients undergoing PCI.
- This assessment is valuable even for short-term follow-up.
Introduction:
An increasing amount of evidence indicates that platelet reactivity, despite a standard anti-thrombotic therapy, is a potential risk factor for recurrent myocardial ischemia in patients with coronary artery disease. We now hypothesize that this condition, measured by collagen-epinephrine (CEPI) or collagen-ADP (CADP) closure times (CT) by Platelet Function Analyzer (PFA-100), may predict the recurrence of coronary events after percutaneous coronary intervention (PCI).
Materials And Methods:
CEPI and CADP-CT were measured 30+/-8 h after PCI in 175 consecutive patients admitted with a diagnosis of stable angina (n=94) or acute coronary syndromes (n=81) and prospectively followed up for a mean period of 6 months. We stratified the patients in accordance to both the CEPI-CT (
Results:
CEPI-CT<190 s as well as CADP-CT<82 s were associated with a higher rate of clinical recurrence (hazard ratio 8.5, p<0.001 and 22.9, p<0.001, respectively). Multivariate analysis after adjustment for other risk factors confirmed that the lowest CADP-CT quartile significantly correlates with the risk of recurrent coronary events (hazard ratio 36.5, p<0.01), as well as CEPI-CT<190 s (hazard ratio 6.7, p=0.01).
Conclusions:
An enhanced platelet function after PCI when measured under high shear rates by PFA-100 is an independent predictor of a worst clinical outcome, even during a short term follow-up and may help in patients risk stratification.
