The relationship between platelet reactivity and infarct-related artery patency in patients presenting with a ST-elevation myocardial infarction

• Published in: Thrombosis and haemostasis Vol. 106; no. 2; p. 331
• Main Authors: Breet, Nicoline J, van Werkum, Jochem W, Bouman, Heleen J, Kelder, Johannes C, Hackeng, Christian M, ten Berg, Jurriën M
• Format: Journal Article
• Language: English
• Published: Germany 01.08.2011
• Subjects: Adenosine Diphosphate - pharmacology; Aged; Angioplasty, Balloon, Coronary; Arachidonic Acid - pharmacology; Cohort Studies; Coronary Angiography; Female; Humans; Leukocyte Count; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Platelet Activation - drug effects; Prospective Studies; Risk Factors; Treatment Outcome; Vascular Patency
• ISSN: 0340-6245
• DOI: 10.1160/TH10-08-0528

Both heightened platelet reactivity and an occluded infarct related artery (IRA) on initial angiography and at the time of primary percutaneous coronary intervention (PCI) are associated with a worsened clinical outcome in patients with ST-elevation myocardial infarction (STEMI). However, the relationship between platelet reactivity and IRA patency has not yet been established. Consecutive STEMI-patients were enrolled in this study. Patients who had TIMI-flow (thrombolysis in myocardial infarction) 0 or 1 on initial angiography constituted the occluded IRA group and patients having TIMI-flow 2 or 3 comprised the IRA patent group. Platelet function measurements were performed using the PFA-100 COL/ADP cartridge and light transmittance aggregometry without agonist (spontaneous) and after stimulation with adenosine diphosphate (ADP) and arachidonic acid (AA). Ninety-nine patients were enrolled, of whom 49 presented with an occluded IRA. Multivariate analysis identified the following independent factors to be associated with an occluded IRA; short COL/ADP closure time (ORper quartile increase=0.60; 95% CI, 0.39-.93; p=0.02), the 20 μM ADP-induced light transmittance aggregometry (ORper quartile increase =1.77; 95% CI, 1.15-2.73; p=0.01) and leukocyte counts (odds ratio [OR]=1.21; 95% CI, 1.05-1.39; p = 0.008). In conclusion, heightened platelet reactivity and elevated leukocyte counts are associated with an occluded IRA upon presentation in STEMI-patients. These results emphasise the importance of potent antithrombotic therapy early after the onset of symptoms, to obtain early recanalisation of the IRA.