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Platelet Reactivity and Intramyocardial Hemorrhage in Patients With ST-Segment Elevation Myocardial Infarction

Łukasz A Małek1, Mariusz Kłopotowski2, Mateusz Śpiewak3

  • 1Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw, Poland lmalek@ikard.pl.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|January 25, 2013
PubMed

Insights

Intramyocardial hemorrhage (IMH) in ST-elevation myocardial infarction (STEMI) patients is linked to reduced platelet aggregation in the subacute phase. This finding suggests a connection between hemorrhage and more effective antiplatelet therapy response.

Area of Science:

  • Cardiology
  • Hematology

Background:

  • ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely intervention.
  • Intramyocardial hemorrhage (IMH) is a potential complication following reperfusion therapy.
  • Understanding factors associated with IMH is crucial for patient management.

Purpose of the Study:

  • To investigate the relationship between platelet reactivity and the presence of intramyocardial hemorrhage (IMH).
  • To assess platelet function before and after reperfusion in STEMI patients with and without IMH.

Main Methods:

  • A cohort of 49 STEMI patients undergoing primary percutaneous coronary intervention was studied.
  • Platelet reactivity was measured using impedance aggregometry (Multiplate) before reperfusion and in the subacute phase.
  • Cardiovascular magnetic resonance imaging (CMR) was employed to detect IMH.

Main Results:

  • IMH was identified in 33% of the patients.
  • No significant differences in pre-reperfusion platelet reactivity were observed between groups.
  • In the subacute phase, patients with IMH showed significantly lower thrombin receptor activating peptide (TRAP)-induced platelet aggregation (P = .004).
  • Trends towards lower ristocetin and collagen-induced platelet aggregation were noted in the IMH group (P = .09 and P = .07).
  • TRAP-induced platelet aggregation and initial perfusion grade were independently associated with IMH.

Conclusions:

  • Intramyocardial hemorrhage in STEMI patients is associated with more potent inhibition of platelet aggregation in the subacute phase.
  • Platelet reactivity, particularly TRAP-induced aggregation, may serve as a marker related to IMH development or its consequences.

Keywords:
ST-segment elevationcardiovascular magnetic resonanceintramyocardial hemorrhagemyocardial infarctionplatelet reactivity

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