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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Impact of platelet turnover on long-term adverse cardiovascular outcomes in patients undergoing percutaneous coronary
Maximilian Tscharre1,2, Serdar Farhan1, Veronika Bruno3
13rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
Insights
Increased platelet turnover, indicated by reticulated platelet count (RPC), predicts long-term adverse cardiovascular events after percutaneous coronary intervention. This finding highlights RPC as a novel atherothrombotic risk marker.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Interventional Cardiology
Background:
- Elevated platelet turnover and reactivity are linked to short-term adverse cardiovascular events post-percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) or stable coronary artery disease (SCAD).
- The long-term prognostic impact of platelet turnover remains less understood.
Purpose of the Study:
- To investigate the association between platelet turnover markers and long-term major adverse cardiovascular events (MACE) in patients undergoing PCI.
- To evaluate reticulated platelet count (RPC) and mean platelet volume (MPV) as predictors of long-term MACE.
Main Methods:
- A cohort of 477 patients with ACS or SCAD undergoing PCI between 2009-2010 were analyzed.
- Patients received dual antithrombotic therapy with clopidogrel and aspirin.
- Multivariable Cox proportional hazard models assessed the prognostic value of RPC and MPV for long-term MACE (cardiovascular death, myocardial infarction, stroke).
Main Results:
- Increased reticulated platelet count (RPC) was significantly associated with long-term MACE, both as a continuous and dichotomized variable, even after multivariable adjustment.
- Neither mean platelet volume (MPV) nor platelet function testing showed a significant association with long-term adverse outcomes.
- Median follow-up was 5.8 years.
Conclusions:
- Increased platelet turnover, specifically higher RPC, is a significant predictor of long-term MACE in patients with coronary artery disease undergoing PCI.
- Platelet turnover emerges as a novel marker for atherothrombotic risk.
- These findings may inform future strategies for tailoring antiplatelet therapy duration or composition.
Background:
Increased platelet turnover and high platelet reactivity are associated with short-term major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) or stable coronary artery disease (SCAD). We investigated the impact of platelet turnover on long-term MACE.
Methods:
Consecutive patients presenting with ACS or SCAD undergoing PCI between 2009 and 2010 were included. All patients received clopidogrel and aspirin as dual antithrombotic therapy regimen. Multivariable Cox proportional hazard models were applied to assess the prognostic impact of platelet turnover (reticulated platelet count [RPC], mean platelet volume [MPV]) and function on long-term MACE, a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke.
Results:
In total, 477 patients were eligible. Mean age was 64.3 ± 12.7 years, 68.8% were male. Median follow-up was 5.8 (IQR 4.2-6.5) years. Median RPC was 7.6 (IQR 5.6-10.4) g/L and median MPV was 10.7 (IQR 10.1-11.3) fL. In univariable analysis, RPC was associated with MACE, both as continuous (HR 1.064 [95%CI 1.021-1.111]; P = .006) and dichotomized (HR 1.693 [95%CI 1.156-2.481]; P = .006) variable. After adjustment, continuous RPC (HR 1.055 [95%CI 1.012-1.099]; P = .010) and dichotomized RPC (HR 1.716 [95%CI 1.152-2.559]; P = .007) remained significantly associated with MACE. Neither MPV nor platelet function testing was associated with long-term adverse outcome.
Conclusion:
Increased platelet turnover is associated with long-term adverse outcome in patients with coronary artery disease undergoing PCI. Platelet turnover represents a new marker of atherothrombotic risk and might help to guide composition or duration of antiplatelet therapy.
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