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Platelet hyperreactivity and prognosis in survivors of myocardial infarction
M D Trip1, V M Cats, F J van Capelle
1Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
Insights
Increased spontaneous platelet aggregation (SPA) in vitro predicts higher mortality and coronary events in myocardial infarction survivors. This simple test can identify high-risk patients needing closer monitoring after a heart attack.
Area of Science:
- Cardiology
- Hematology
- Biomarkers
Background:
- Platelet aggregation plays a crucial role in thrombotic events.
- Identifying reliable predictors of future cardiac events is vital for post-myocardial infarction patient management.
Purpose of the Study:
- To investigate whether in vitro spontaneous platelet aggregation (SPA) predicts mortality and coronary events.
- To assess the prognostic value of SPA in survivors of myocardial infarction over a five-year follow-up period.
Main Methods:
- A cohort of 149 myocardial infarction survivors was followed for five years.
- Spontaneous platelet aggregation (SPA) was tested at baseline and every six months, categorized as negative, intermediate, or positive.
- Outcomes including mortality and cardiac events were recorded.
Main Results:
- Patients with positive SPA had a significantly higher risk of death (relative risk 5.4) and cardiac events (46.2%) compared to SPA-negative patients.
- The SPA-intermediate group also showed an increased risk compared to the SPA-negative group.
- Prognostic value of positive SPA persisted throughout the five-year study.
Conclusions:
- In vitro spontaneous platelet aggregation is a valuable biologic marker for predicting coronary events and mortality in myocardial infarction survivors.
- This finding suggests a potential role for SPA in risk stratification and guiding clinical management.
- While a causal relationship is suggested, further research is needed for confirmation.
Abstract:
We tested the hypothesis that an increase in spontaneous aggregability of platelets in vitro predicts mortality and coronary events in patients who have survived a recent myocardial infarction. A cohort of 149 survivors of infarction entered our study three months after the index infarction and was followed for five years. At entry and at intervals of six months, spontaneous platelet aggregation (SPA) was tested and graded as positive (aggregation within 10 minutes), intermediate (aggregation after 10 to 20 minutes), or negative (no aggregation within 20 minutes). During follow-up, 6.4 percent (6 of 94) of the patients in the SPA-negative group died, as compared with 10.3 percent (3 of 29) in the SPA-intermediate group and 34.6 percent (9 of 26) in the SPA-positive group. As compared with the SPA-negative group, the SPA-intermediate group had a relative risk of death of 1.6 (95 percent confidence interval, 0.5 to 5.5) and the SPA-positive group had a risk of 5.4 (95 percent confidence interval, 2.2 to 13.4). At least one cardiac event (cardiac death or recurrent nonfatal myocardial infarction) occurred in 14.9 percent (14 of 94 patients) of the SPA-negative group, 24.1 percent (7 of 29) of the SPA-intermediate group, and 46.2 percent (12 of 26) of the SPA-positive group. A positive test result continued to have prognostic value throughout the five-year study. We conclude that spontaneous platelet aggregation in vitro is a useful biologic marker for the prediction of coronary events and mortality in this low-risk group of survivors of a myocardial infarction. A causal relation is suggested but not proved by our study.