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Published on: November 8, 2024
Increased Platelet FcɣRIIa Identifies Patients at Greater Risk of Multiple Cardiovascular Events After Myocardial
David J Schneider1, Dominick J Angiolillo2, Homam Ibrahim3
1Department of Medicine, Cardiovascular Research Institute, The University of Vermont, Burlington, Vermont, USA.
Insights
Quantifying platelet FcɣRIIa (pFCG) after myocardial infarction stratifies ischemic risk. High pFCG levels are linked to increased risk of both initial and recurrent ischemic events, aiding clinical decisions.
Area of Science:
- Cardiology
- Immunology
- Biomarker Discovery
Background:
- Platelet FcɣRIIa (pFCG) quantification is crucial for stratifying ischemic risk post-myocardial infarction (MI).
- Understanding pFCG's prognostic value is essential for managing patients with type 1 MI.
Purpose of the Study:
- To evaluate platelet FcɣRIIa (pFCG) as a prognostic biomarker in patients experiencing subsequent ischemic and bleeding events.
- To assess the association between pFCG levels and the occurrence of adverse cardiovascular events.
Main Methods:
- A prospective trial enrolled 765 patients with type 1 MI and specific risk factors (age ≥65, multivessel CAD, prior MI, CKD, diabetes).
- Platelet FcɣRIIa (pFCG) was quantified using flow cytometry.
- Ischemic endpoints included MI, stroke, and death; bleeding endpoints were defined by BARC criteria.
Main Results:
- Higher pFCG levels correlated significantly with increased risk of first and multiple ischemic events, including fatal MI (P < 0.001 for trend).
- High pFCG was associated with a 2.7-fold increased risk of recurrent ischemic events between 6 months and 1 year (HR: 2.7; 95% CI: 1.82-4.02; P < 0.0001).
- pFCG levels in patients with bleeding events (without ischemia) were similar to those without any adverse events.
Conclusions:
- Elevated platelet FcɣRIIa (pFCG) is a significant predictor of both initial and recurrent ischemic events after myocardial infarction.
- pFCG may serve as a valuable biomarker to guide clinical decision-making in MI patients at high risk for ischemic complications.
Background:
After myocardial infarction (MI), quantifying platelet FcɣRIIa (pFCG) stratifies ischemic risk.
Objectives:
This study aimed to assess a prognostic biomarker, pFCG, in patients with and without subsequent ischemic and bleeding events.
Methods:
Patients (n = 765) with type 1 MI were enrolled in a prospective noninterventional trial. Inclusion criteria included at least 2 of the following: age ≥65 years, multivessel coronary artery disease, prior MI, chronic kidney disease, and diabetes. Flow cytometry quantified pFCG at a core laboratory. Ischemic endpoints (n = 158) were MI, stroke, and death. Bleeding endpoints (n = 74) were Bleeding Academic Research Consortium 2, 3, and 5.
Results:
Patients were categorized as no events (n = 562), bleeding events alone (n = 45), single ischemic event (n = 101), bleeding + ischemic events (n = 29), multiple ischemic events (n = 23), and fatal MI (defined as MI combined with death within 2 days, n = 5). Average pFCG (molecules/platelet) in patient groups was 1,491 ± 655 (no events), 1700 ± 740 (single ischemic), 1850 ± 625 (multiple ischemic), and 1880 ± 440 (fatal MI, P < 0.001 for trend). Early ischemic events associated with high pFCG were driven by first ischemic endpoints and were accentuated between 6 months and 1 year by additional ischemic endpoints (HR: 2.7; 95% CI: 1.82-4.02; P < 0.0001). The average expression (molecules/platelet) in patients with bleeding (without ischemia) 1,491 ± 517 was similar to that in patients without ischemia or bleeding.
Conclusions:
High pFCG is associated with a greater risk of both first and additional ischemic endpoints. The strong association of pFCG with a greater risk of recurrent ischemic events may be useful to inform clinical decision-making.
Clinical Trial Registration Information:
NCT05175261.
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