Hamostaseologie
DOI: 10.1055/a-2299-0130
Original Article

Baseline Platelet Count Predicts Infarct Size and Mortality after Acute Myocardial Infarction

Alexander Dutsch*
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
2   German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich Germany
,
Christian Graesser*
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
2   German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich Germany
,
Sophie Novacek
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
,
Johannes Krefting
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
,
Viktoria Schories
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
,
Benedikt Niedermeier
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
,
Felix Voll
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
,
Sebastian Kufner
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
2   German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich Germany
,
Erion Xhepa
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
,
Michael Joner
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
2   German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich Germany
,
Salvatore Cassese
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
,
Heribert Schunkert
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
2   German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich Germany
,
Gjin Ndrepepa
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
,
Adnan Kastrati
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
2   German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich Germany
,
Thorsten Kessler*
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
2   German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich Germany
,
Hendrik B. Sager*
1   Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
2   German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich Germany
› Author Affiliations

Funding H.B.S. has received funding from the European Research Council under the European Union's Horizon 2020 Research and Innovation Programme (STRATO, grant agreement no. 759272), the “Else-Kröner-Fresenius-Stiftung” (2020_EKSE.07), and the “Deutsche Forschungsgemeinschaft (DFG)” (515567441, 470462396, CRC 1123 (B11)). H.B.S. received lecture fees and travel support from Novo Nordisk Pharma GmbH, AstraZeneca GmbH, and Abbott Medical GmbH. S.K. reports speaker and consulting fees from Bristol Myers Squibb and Bentley and speaker fees from AstraZeneca and Translumina not related to the current work.
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Abstract

Introduction Platelets greatly contribute to cardiovascular diseases. We sought to explore the association of platelet counts with infarct size and outcome in patients presenting with acute ST-segment elevation MI (STEMI) treated with primary percutaneous coronary intervention (PPCI).

Methods and Results In this retrospective study, we grouped 1,198 STEMI patients into tertiles (T) based on platelet count on admission: T1 = 102–206 [109 platelets/L] (n = 402), T2 = 207–259 [109 platelets/L] (n = 396), and T3 = 260–921 [109 platelets/L] (n = 400). Primary endpoint was 1-year all-cause mortality. Patients with highest platelet counts on admission showed the greatest area at risk and infarct size: area at risk (median) was 22.0% (interquartile range [IQR]: 12.0–39.8%) in T1, 21.0% (IQR: 11.0–37.1%) in T2, and 26.0% (IQR: 14.9–45.0%) of the left ventricle in T3 (p = 0.003); final infarct sizes after 7 to 14 days were as follows: 10.0% (IQR: 2.0–21.0%) in T1, 9.0% (IQR: 2.0–20.7%) in T2, and 12.0% (IQR: 3.0–27.3%) of the left ventricle in T3 (p = 0.015) as serial imaging revealed. At 1 year, 16 all-cause deaths occurred in T1, 5 in T2, and 22 in T3 (log-rank test, p = 0.006). After adjustment, T1 and T3 were associated with all-cause 1-year mortality (T1: hazard ratio [HR] = 3.40, 95% confidence interval [CI] = 1.23–9.54, p = 0.02; T3: HR = 3.55, 95% CI = 1.23–9.78, p = 0.01) compared with T2. At 5 years, all-cause mortality remained numerically higher in the T1 and T3.

Conclusions In patients with STEMI undergoing PPCI, low and high blood platelet levels on admission were associated with increased long-term mortality ([Fig. 1]).

* These authors contributed equally.


Supplementary Material



Publication History

Received: 09 January 2024

Accepted: 01 April 2024

Article published online:
04 October 2024

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