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Platelet counts on admission affect coronary flow, myocardial perfusion and left ventricular systolic function after
Dawod Sharif1,2, Mira Abu-Salem2, Amal Sharif-Rasslan2,3
11 Cardiology Department, Bnai Zion Medical Center, Israel.
Insights
Lower platelet counts in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention indicate better coronary flow and myocardial perfusion. Conversely, higher platelet counts are associated with impaired left ventricular systolic function.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hematology
Background:
- Elevated platelet counts in ST-elevation myocardial infarction (STEMI) patients treated with fibrinolysis correlate with poorer clinical outcomes.
- Primary percutaneous coronary intervention (PCI) is a key treatment for acute STEMI.
Purpose of the Study:
- To investigate the impact of admission platelet count on coronary flow, myocardial perfusion, and left ventricular systolic function recovery in STEMI patients treated with primary PCI.
- To test the hypothesis that platelet count influences key indicators of cardiac recovery post-primary PCI.
Main Methods:
- 174 anterior STEMI patients undergoing primary PCI were stratified into four platelet count groups: <200 K, 200-300 K, 300-400 K, and >400 K.
- Coronary artery flow and myocardial blush were assessed using TIMI criteria.
- Doppler echocardiography evaluated left anterior descending (LAD) coronary artery velocities and left ventricular (LV) function (ejection fraction, WMSI) pre- and post-PCI.
Main Results:
- Post-PCI TIMI flow, myocardial blush, and ST elevation resolution were comparable across all platelet count groups.
- Patients with platelet counts <200 K exhibited higher peak diastolic LAD velocities and a greater incidence of LAD velocity deceleration time >600 ms, suggesting improved myocardial perfusion.
- Patients with platelet counts >400 K showed significantly worse LV ejection fraction and WMSI, both at admission and pre-discharge.
Conclusions:
- Lower admission platelet counts in STEMI patients treated with primary PCI are associated with enhanced coronary diastolic velocities and improved myocardial perfusion.
- Higher platelet counts are linked to diminished left ventricular systolic function in STEMI patients undergoing primary PCI.
- Platelet count serves as a potential prognostic marker in STEMI patients treated with primary PCI, influencing cardiac recovery and function.
Background:
Patients with acute ST-elevation myocardial infarction (STEMI) and increased platelet count treated by fibrinolysis have worse outcomes.
Aim:
The aim of this study was to test the hypothesis that platelet blood count at admission in patients with acute STEMI treated by primary percutaneous coronary intervention affects coronary flow, myocardial perfusion and recovery of left ventricular systolic function.
Methods:
A total of 174 patients presenting with acute anterior STEMI and treated with primary percutaneous coronary intervention were included and divided into subgroups of admission platelet blood count of <200 K, 200-300 K, 300-400 K and >400 K. Evaluation of coronary artery flow and myocardial blush grade was performed according to the TIMI criteria. Electrocardiographic ST elevation resolution post-primary percutaneous coronary intervention was evaluated. Doppler echocardiographic evaluation of left anterior descending coronary artery velocities early and late after primary percutaneous coronary intervention and assessment of left ventricular ejection fraction and wall motion score index (WMSI) of left ventricular and left anterior descending coronary artery territory were performed.
Results:
Post-primary percutaneous coronary intervention TIMI, myocardial blush grade and ST elevation resolution were similar in all groups. Patients with platelet counts <200 K had higher peak diastolic left anterior descending coronary artery velocity both early and late after primary percutaneous coronary intervention, and higher prevalence of left anterior descending coronary artery velocity deceleration time exceeding 600 ms, (45.5% vs. 40%, P<0.05). Patients with platelet counts >400 K presented with worse left ventricular ejection fraction, left ventricular WMSI and left anterior descending coronary artery WMSI, and before discharge this subgroup had worse left ventricular WMSI and left anterior descending coronary artery WMSI, P<0.01.
Conclusions:
Patients with anterior STEMI treated by primary percutaneous coronary intervention with lower admission platelet count had higher left anterior descending coronary artery diastolic velocities, better myocardial perfusion with more patients having left anterior descending coronary artery-descending coronary artery velocity deceleration time >600 ms. Patients with higher platelet counts had lower left ventricular systolic function both at admission and before discharge.
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