Patients with Coronary Artery Disease who Present with Chest Pain Have Significantly Elevated Platelet Contractile Force and Clot Elastic Modulus

Summary

Rapid laboratory markers that correlate with patient risk would facilitate the decision making regarding admission of patients with chest pain (CP). Platelet contractile force (PCF) and clot elastic modulus (CEM) are elevated in patients undergoing coronary bypass grafting. This study assessed PCF, CEM, and platelet aggregation in patients presenting to the emergency department with chest pain (CP). Results were compared with fifty normal controls. Both the total group of CP patients (n = 100) and the subset of patients (n = 36) with documented coronary arterys disease (CAD) had significantly elevated PCF and CEM, and significantly decreased platelet aggregation relative to normal (p <0.001 for the total group, p <0.008 for patients with CAD). Patients with electrocardiographic evidence of ischemia had the highest PCF and CEM values of any patient group. Increased PCF and CEM were not due to higher platelet counts, and PCF did not differ by race.

Keywords

Coronary artery disease - angina - platelet contractile force - platelet aggregation

• References

• 1 Kristensen SD, Lassen JF, Ravn HB. Pathopysiology of coronary thrombosis. Semin Interv Cardiol 2000; 05: 109-15.
• 2 Fitzgerald DJ, Louis R, Catella F, Fitzgerald GA. Platelet activation in unstable coronary disease. N Engl J Med 1986; 315: 983-9.
• 3 Willerson JT, Campbell WB, Winniford MD, Schmitz J, Apprill P, Firth BG, Ashton J, Smitherman T, Bush L, Buja LM. Conversion from chronic to acute coronary artery disease: Speculation regarding mechanisms. Am J Cardiol 1984; 54: 1349-54.
• 4 Buja ML, Willerson JT. Clinicopathologic correlates of acute ischemic heart disease syndromes. Am J Cardiol 1981; 47: 343-56.
• 5 Willerson JT, Golino P, Eidt J, Campbell WB, Buja LM. Specific platelet mediators and unstable coronary artery lesions Experimental evidence and potential clinical implications. Circulation 1989; 80: 198-205.
• 6 Lee TH, Rouan GW, Weisberg MC, Brand DA, Acampora D, Stasiulewicz C, Walshon J, Terranova G, Gottlieb L, Goldstein-Wayne B. et al. Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Am J Cardiol 1987; 60: 219-24.
• 7 McCarthy BD, Beshansky JR, D’Agostino RB, Selker HP. Missed diagnoses of acute myocardial infarction in the emergency department: results from a multicenter study. Ann Emerg Med 1993; 22: 579-82.
• 8 Kontos MC, Jesse RL, Schmidt KL, Ornato JP, Tatum JL. Value of acute rest sestamibi perfusion imaging for evaluation of patients admitted to the emergency department with chest pain. JACC 1997; 30: 976-82.
• 9 Varetto T, Cantalupi D, Altieri A, Orlandi C. Emergency room technetium-99m sestamibi imaging to rule out acute myocardial ischemic events in patients with nondiagnostic electrocardiograms. JACC 1993; 22: 1804-8.
• 10 Hilton TC, Thompson RC, Williams HJ, Saylors R, Fulmer H, Stowers SA. Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain. JACC 1994; 23: 1016-22.
• 11 Lindahl B, Diderholm E, Lagerqvist B, Venge P, Wallentin L. Mechanisms behind the prognostic value of troponin T in unstable coronary artery disease: a FRISC II substudy. J Am Coll Cardiol 2001; 38: 979-86.
• 12 Ohman EM, Armstrong PW, Christenson RH, Granger CB, Katus HA, Hamm CW, O’Hanesian MA, Wagner GS, Kleiman NS, Harrell Jr FE, Califf RM, Topol EJ. Cardiac troponin T levels for risk stratification acute myocardial ischemia. N Engl J Med 1996; 335: 1333-41.
• 13 Trip MD, Cats VM, van Capelle FJ, Vreeken J. Platelet hyperreactivity and prognosis in survivors of myocardial infarction. N Engl J Med 1990; 322: 1549-54.
• 14 Ikeda H, Nakayama H, Oda T, Kuwano K, Muraishi A, Sugi K, Koga Y, Toshima H. Soluble form of P-selectin in patients with acute myocardial infarction. Coron Artery Dis 1994; 05: 515-8.
• 15 Shyu KG, Chang H, Lin CC, Kuan P. Circulating intercellular adhesion molecule-1 and E-selectin in patients with acute coronary syndrome. Chest 1996; 109: 1627-30.
• 16 Greilich PE, Carr ME, Zekert SL, Dent RM. Quantitative Assessment of Platelet Function and Clot Structure in Patients with Severe Coronary Artery Disease. Am J Med Sci 1994; 307: 15-20.
• 17 Carr ME. Measurement of platelet force: the Hemodyne® hemostasis analyzer. Clin Lab Manage Rev 1995; 09: 312-9.
• 18 Carr ME, Zekert SL. Measurement of platelet-mediated force development during plasma clot formation. Am J Med Sci 1991; 302: 13-8.
• 19 Carr ME, Martin EJ, Carr SL. Delayed, reduced or inhibited thrombin production reduces platelet contractile force and results in weaker clot formation. Blood Coagul Fibrinolysis 2002; 13: 193-7.
• 20 Tatum JL, Jesse RL, Kontos MC, Nicholson CS, Schmidt KL, Roberts CS, Ornato JP. Comprehensive strategy for the evaluation and triage of the chest pain patient. Ann Emerg Med 1997; 29: 116-25.
• 21 Carr ME, Zekert SL. Abnormal clot retraction, altered fibrin structure, and normal platelet function in multiple myeloma. Am J Physiol 1994; 266: H1195-201.
• 22 Carr ME, Carr SL. Fibrin structure and concentration alter clot elastic modulus but do not alter platelet mediated force development. Blood Coagul Fibrinolysis 1995; 06: 79.
• 23 Becker RC, Bovill EG, Corrao JM, Ball SP, Ault K, Mann KG, Tracy RP. Dynamic nature of thrombin generation, fibrin formation, and platelet activation in unstable angina and non-Q-wave myocardial infarction. J Thromb Thrombolysis 1995; 02: 57-64.
• 24 Tataru MC, Schulte H, von Eckardstein A, Heinrich J, Assmann G, Koehler E. Plasma fibrinogen in relation to the severity of arteriosclerosis in patients with stable angina pectoris after myocardial infarction. Coron Artery Dis 2001; 12: 157-65.
• 25 Johnsson R, Harjola PT, Siltanen P. Effect of pentoxifylline on red cell flexibility in arterio-sclerotic patients and in patients with heart valve prosthesis. Scand J Clin Lab Invest Suppl 1981; 156: 297-300.
• 26 Carr Jr ME, Carr SL, Hantgan RR, Braaten J. Glycoprotein IIb/IIIa Blockade Inhibits Platelet Mediated Force Development and Reduces Gel Elastic Modulus. Thromb Haemost 1995; 73: 499-505.
• 27 Carr ME, Carr SL, Greilich PE. Heparin ablates force development during platelet mediated clot retraction. Thromb Haemost 1996; 75: 674-8.
• 28 Rho R, Tracy RP, Bovill EG, Ball SP, Becker RC. Plasma markers of procoagulant activity among individuals with coronary artery disease. J Throm Thrombolysis 1995; 02: 239-43.
• 29 Figueras J, Monasterio Y, Lidon RM, Nieto E, Soler-Soler J. Thrombin formation and fibrinolytic activity in patients with acute myocardial infarction or unstable angina: in-hospital course and relationship with recurrent angina at rest. J Am Coll Cardiol 2000; 36: 2036-43.
• 30 McKenzie ME, Pothula A, Gurbel PA, Fuzaylov SY, O’Connor CM, Gattis WA, Serebruany VL. Failure of thrombin generation markers to triage patients presenting with chest pain. Cardiology 1999; 92: 53-8.
• 31 Neumann FJ, Ott I, Gawaz M, Puchner G, Schomig A. Neutrophil and platelet activation at balloon-injured coronary artery plaque in patients undergoing angioplasty. J Am Coll Cardiol 1996; 27: 819-24.
• 32 Prazich JA, Rapaport SI, Samples JR, Engler R. Platelet aggregate ratios – standardization of technique and test results in patients with myocardial ischemia and patients with cerebrovascular disease. Thromb Haemost 1997; 38: 597-605.
• 33 Jaffy MB, Meischke H, Eisenberg MS. Prevalence of aspirin use among patients calling 9-1-1 for chest pain. Acad Emerg Med 1998; 05: 1146-9.
• 34 Garcia-Dorado D, Theroux P, Tornos P, Sambola A, Oliveras J, Santos M, Soler JSoler. Previous aspirin use may attenuate the severity of the manifestation of acute ischemic syndromes. Circulation 1995; 92: 1743-8.
• 35 Carr Jr ME, Hines S, Carr SL, Todd WM, Taylor TL, Mohanty L. Storage pool disease in chronic lymphocytic leukemia: abnormal aggregation and secretion without bleeding. Am J Med Sci 1997; 313: 176-81.