Objective-Our aim in this study was to provide novel information on the molecular mechanisms playing a major role in the unwanted platelet activation associated with ST-elevation myocardial infarction (STEMI). Methods and Results-We compared the platelet proteome of 11 STEMI patients to a matched control group of 15 stable chronic ischemic cardiopathy patients. In addition, we did a prospective study to follow the STEMI patients over time.Proteins were separated by high-resolution 2D gel electrophoresis, identified by mass spectrometry, and validated by Western blotting. Platelets from STEMI patients on admission displayed 56 protein spot differences (corresponding to 42 unique genes) compared with the control group. The number of differences decreased with time during the patients' follow-up. Interestingly, the adapter protein CrkL and the active form of Src (phosphorylated in Tyr418) were found to be upregulated in platelets from STEMI patients. Major signaling pathways related to the proteins identified include integrin, integrin-linked kinase, and glycoprotein VI (GPVI) signaling. Interestingly, a study on an independent cohort of patients showed a higher degree of activation of GPVI signaling in STEMI patients. Conclusion-CrkL, the active form of Src, and GPVI signaling are upregulated in platelets from STEMI patients. Key Words: acute coronary syndromes Ⅲ platelets Ⅲ GPVI signaling Ⅲ proteomics A cute coronary syndromes (ACSs) encompass unstable angina, non-ST segment elevation (NSTE) myocardial infarction, and ST-segment elevation myocardial infarction (STEMI). The latter usually occurs when thrombus forms on a ruptured atheromatous plaque and causes a prolonged occlusion of an epicardial coronary artery. 1 There is no doubt platelets play a fundamental role in the pathogenesis of an ACS, being implicated in the thrombus formation that follows the atheroma plaque rupture. 2 Activated platelets release proteins in the coronary circulation of ACS patients, such as matrix metalloproteinases, that contribute to sustained intracoronary platelet activation. 3 Following an ACS, antiplatelet therapy is recommended to reduce the growth of a thrombus. Primary targets of such therapy are molecules involved in platelet activation and aggregation. Nevertheless, there is a need for the development of a new generation of safer and more effective antithrombotic drugs with larger therapeutic windows and for a better understanding of the pathogenic processes that lead to thrombotic occlusion of blood vessels linked to an acute event. 2 Proteomics has emerged as a promising tool in cardiovascular research, and more precisely in the study of ACSs. 4 Studies have included plasma, monocytes, and, very recently, platelets. [5][6][7][8] The objective of these studies was the identification of novel screening and diagnostic biomarkers that might help to predict the disease and provide novel information on the molecular events associated with it, hopefully leading to the identification of novel drug targets. We have been inv...