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Thromb Haemost 2011; 106(02): 331-336
DOI: 10.1160/TH10-08-0528
Platelets and Blood Cells
Schattauer GmbH

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

Nicoline J. Breet
1   St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, the Netherlands
2   Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Jochem W. van Werkum
1   St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, the Netherlands
2   Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Heleen J. Bouman
1   St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, the Netherlands
2   Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Johannes C. Kelder
1   St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, the Netherlands
2   Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Christian M. Hackeng
1   St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, the Netherlands
3   Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, the Netherlands
,
Jurriën M. ten Berg
1   St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, the Netherlands
2   Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
› Author Affiliations
Further Information

Publication History

Received: 16 August 2010

Accepted after major revision: 25 June 2010

Publication Date:
25 November 2017 (online)

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Summary

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–l2.73; 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.

keywords

ST-elevation myocardial infarction - infarct-related artery - clopidogrel - platelet reactivity
 

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