Systemic inflammatory status is associated with increased platelet reactivity in the early period after acute
Stefano Cornara1, Gabriele Crimi2, Alberto Somaschini1
1a Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
Insights
Elevated C-reactive protein (CRP) levels one month after non-ST elevation acute coronary syndrome (ACS) are linked to higher residual high platelet reactivity (HPR). This association may explain adverse cardiovascular outcomes in these patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Biomarkers
Background:
- Systemic inflammation, indicated by C-reactive protein (CRP), correlates with major adverse cardiovascular events (MACE).
- Targeting CRP has shown promise in reducing MACE post-acute coronary syndrome (ACS).
- High platelet reactivity (HPR) is an independent MACE predictor in ACS patients, potentially linked to inflammation.
Purpose of the Study:
- To investigate the association between 1-month C-reactive Protein (CRP) levels and high platelet reactivity (HPR) in patients following non-ST elevation ACS.
- To determine if elevated CRP predicts residual HPR at 30 days post-ACS.
Main Methods:
- The GEPRESS study enrolled 1042 patients; CRP and platelet reactivity index (PRI) were measured at 30-day follow-up.
- Platelet reactivity was assessed using the vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay.
- High platelet reactivity (HPR) was defined as a PRI >50%.
Main Results:
- Data from 756 patients showed HPR in 49.1% with CRP >1 mg/L versus 36.4% with CRP ≤1 mg/L (p=0.012).
- A direct relationship was observed between CRP levels and HPR after adjusting for covariates.
- Including CRP significantly improved the predictive model for HPR.
Conclusions:
- This study demonstrates that elevated CRP (>1 mg/L) at 1 month post-ACS is associated with a higher likelihood of residual high platelet reactivity.
- This persistent HPR in the setting of elevated CRP may contribute to adverse cardiovascular outcomes in ACS patients.
- CRP levels serve as a valuable indicator for residual platelet activity and potential risk stratification in ACS management.
Abstract:
Systemic inflammation measured by high-sensitivity C reactive protein (CPR) is associated with increased risk of major adverse cardiovascular events (MACE). Recent clinical trials targeting CPR showed a reduction in MACE after an acute coronary syndrome (ACS). Inflammation could be linked to high platelet reactivity (HPR), which is an independent predictor of MACE in patients with ACS. We aimed to evaluate the impact of 1-month C-reactive Protein (CRP) levels on HPR in patients enrolled in the GEPRESS study. We measured CRP and platelet reactivity index (PRI) at 30 days follow-up. PRI was assessed with vasodilator stimulated phosphoprotein (VASP) phosphorylation assay at the same timepoint. HPR was defined as PRI >50%. Of the 1042 patients included in the GEPRESS study, 756 (75%) had both VASP and CRP data at 30 days follow-up. HPR was found in 61 (49.1%) patients with CRP >1 mg/L and 233 (36.4%) patients with CRP ≤1 mg/L, p = 0.012. After adjustment for covariates, we found a direct gradient of effect between CRP and HPR; the inclusion of CRP significantly increased the discrimination of HPR regression model. This is the first study showing that residual HPR is more likely to occur in patients with CRP >1 mg/L at 1 month after non-ST elevation-ACS and this may contribute to the unfavorable outcome observed in such patients.
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