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Published on: January 28, 2020
Prognostic implication of systemic inflammatory state on antiplatelet effect in patients after percutaneous coronary
Hairui Jiang1, Hao Wang2, Bo Liang1
1Department of Cardiology.
Insights
Systemic inflammation, indicated by high-sensitivity C-reactive protein (hs-CRP), impairs antiplatelet therapy in ST-elevation myocardial infarction (STEMI) patients. Elevated hs-CRP levels predict major adverse cardiac events (MACEs), highlighting its prognostic value.
Area of Science:
- Cardiology
- Clinical Medicine
- Biomarkers
Background:
- Systemic inflammation is a known factor influencing outcomes in ST-elevation myocardial infarction (STEMI).
- Inflammatory markers can affect platelet aggregation and the efficacy of antiplatelet therapies.
- The prognostic significance of systemic inflammation in STEMI patients undergoing percutaneous coronary intervention (PCI) requires further evaluation.
Purpose of the Study:
- To assess the prognostic implication of systemic inflammatory state, measured by high-sensitivity C-reactive protein (hs-CRP), in STEMI patients undergoing primary PCI.
- To investigate the relationship between hs-CRP levels, residual platelet reactivity, and major adverse cardiac events (MACEs).
Main Methods:
- A cohort of 203 STEMI patients undergoing primary PCI were stratified into three groups based on admission hs-CRP tertiles.
- Platelet aggregation was assessed using residual ADP-induced light transmittance aggregometry post-clopidogrel therapy.
- Major adverse cardiac events (MACEs) were meticulously defined and tracked during follow-up.
Main Results:
- Higher hs-CRP tertiles correlated with elevated white blood cell counts and significantly higher residual platelet aggregation.
- Multivariate analysis identified hs-CRP, reperfusion time, alanine aminotransferase, platelet count, and follow-up platelet aggregometry as independent predictors of MACEs.
- Decreased platelet inhibition by clopidogrel was observed at higher inflammation levels, with hs-CRP levels significantly associated with MACEs.
Conclusions:
- High-sensitivity C-reactive protein (hs-CRP) is significantly associated with impaired platelet inhibition by clopidogrel in STEMI patients.
- Admission hs-CRP levels serve as a valuable prognostic marker for predicting major adverse cardiac events (MACEs) in STEMI patients post-PCI.
Abstract:
Patients with ST-elevation myocardial infarction (STEMI) show an inflammatory response. The level of systemic inflammation is known to affect platelet aggregation function and antiplatelet therapy, which leads to different clinical prognosis. This study aims to evaluate the prognostic implication of systemic inflammatory state in patients with STEMI undergoing percutaneous coronary intervention.In this study, 203 patients with STEMI who underwent primary percutaneous coronary intervention were included. The patients were divided into 3 groups based on the inflammation levels assessed by tertiles of high-sensitivity C-reactive protein (hs-CRP) level on admission. Platelet aggregation evaluation was performed by residual platelet reactivity, which was assessed by the value of residual ADP-induced light transmittance aggregometry after clopidogrel maintenance dose therapy and in follow-up. Major adverse cardiac events (MACEs) were defined to include all-cause mortality, cardiovascular mortality, reinfarction, target vessel revascularization (TVR), cardiopulmonary resuscitation, advanced heart failure, ventricular fibrillation or ventricular tachycardia, and atrioventricular block.Levels of white blood cell was observed to be significantly higher at high tertile levels. Residual ADP-induced platelet aggregation was significantly higher at high tertile levels after clopidogrel maintenance dose therapy and in follow-up. Multivariate analysis identified that reperfusion time, alanine aminotransferase, platelet count, ADP-induced light transmittance aggregometry in follow-up and hs-CRP was independent predictors of MACEs. Platelet inhibition function of clopidogrel decreases progressively at different inflammation levels. The different levels of hs-CRP were demonstrated to be associated with MACEs at follow-up assessments.The presence of hs-CRP was not only significantly associated with platelet inhibition function, but was also a prognostic marker in STEMI.
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