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Published on: January 31, 2018
Circulating Platelet-Derived Microparticles Associated with Postdischarge Major Adverse Cardiac Events in
Anggoro Budi Hartopo1, Dyah Samti Mayasari1, Ira Puspitawati2
1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, Indonesia.
Insights
Platelet-derived microparticles (PDMPs) increase after ST-elevation myocardial infarction (STEMI). A sustained rise in PDMPs within 30 days post-discharge predicts short-term major adverse cardiac events (MACE) in STEMI patients.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Biomarker Research
Background:
- Platelet-derived microparticles (PDMPs) are emerging biomarkers with prognostic value in ST-elevation acute myocardial infarction (STEMI).
- The long-term prognostic significance of PDMPs in STEMI patients requires further investigation and validation.
- Understanding PDMP dynamics post-STEMI is crucial for refining risk stratification and patient management strategies.
Purpose of the Study:
- To investigate the dynamic changes in PDMP levels from hospital admission to 30 days post-discharge in STEMI patients.
- To evaluate the association between PDMP levels and major adverse cardiac events (MACE) up to one year after discharge.
- To determine if a persistent increase in PDMPs is linked to adverse cardiovascular outcomes in STEMI survivors.
Main Methods:
- A prospective cohort study involving 101 consecutive STEMI patients.
- PDMPs, defined as CD41(+) and CD62P(+) microparticles, were quantified using flow cytometry on admission and at 30 days post-discharge.
- Major adverse cardiac events (MACE), including cardiac death, heart failure, cardiogenic shock, reinfarction, and resuscitated ventricular arrhythmia, were tracked for one year.
Main Results:
- No significant difference in PDMP levels was observed between patients with and without MACE during hospitalization (p=0.874).
- Forty-five patients exhibited increased PDMP levels at 30 days post-discharge compared to admission levels.
- Patients with increased PDMPs at 30 days post-discharge had significantly higher rates of 30-day MACE (37.8% vs. 16.7%, p=0.036) and a trend towards higher MACE at 90 days (48.9% vs. 30.6%, p=0.095) and 1 year (48.9% vs. 36.1%, p=0.249).
Conclusions:
- PDMP levels significantly increase from hospital admission to 30 days post-discharge in STEMI patients.
- A persistent increase in PDMP levels 30 days after a STEMI event is associated with increased 30-day MACE.
- Sustained elevation of PDMPs shows a trend towards predicting higher MACE at 90 days and 1 year post-discharge, highlighting their potential as dynamic prognostic markers.
Introduction:
Platelet-derived microparticles (PDMPs) measurement adds prognostic implication for ST-elevation acute myocardial infarction (STEMI). The long-term implication of PDMPs in STEMI needs to be corroborated.
Methods:
The research design was a cohort study. Subjects were STEMI patients and were enrolled consecutively. The PDMPs were defined as microparticles bearing CD41(+) and CD62P(+) markers detected with flow cytometry. The PDMPs were measured on hospital admission and 30 days after discharge. The outcomes were major adverse cardiac events (MACE), i.e., a composite of cardiac death, heart failure, cardiogenic shock, reinfarction, and resuscitated ventricular arrhythmia, occurring from hospitalization until 1 year after discharge.
Results:
We enrolled 101 subjects with STEMI. During hospitalization, 17 subjects (16.8%) developed MACE. The PDMPs were not different between subjects with MACE and those without (median (IQR): 3305.0/μL (2370.0-14690.5/μL) vs. 4452.0/μL (2024.3-14396.8/μL), p=0.874). Forty-five subjects had increased PDMPs in 30 days after discharge as compared with on-admission measurement. Subjects with increased PDMPs had significantly higher 30-day MACE as compared to subjects with decreased PDMPs 17 (37.8%) vs. 6 (16.7%, p=0.036). There was a trend toward higher MACE in subjects with increased PDMPs as compared to those with decreased PDMPs in 90 days after discharge (48.9% vs. 30.6%, p=0.095) and 1 year after discharge (48.9% vs. 36.1%, p=0.249).
Conclusion:
The PDMPs level was increased from the day of admission to 30 days after discharge in patients with STEMI. The persistent increase in the PDMPs level in 30 days after the STEMI event was associated with the 30-day postdischarge MACE and trended toward increased MACE during the 90-day and 1-year follow-up.
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