Impact of platelet turnover on long‐term adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention

Abstract

Background: Increased platelet turnover and high platelet reactivity are associated with short-term major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) or stable coronary artery disease (SCAD). We investigated the impact of platelet turnover on long-term MACE. Methods: Consecutive patients presenting with ACS or SCAD undergoing PCI between 2009 and 2010 were included. All patients received clopidogrel and aspirin as dual antithrombotic therapy regimen. Multivariable Cox proportional hazard models were applied to assess the prognostic impact of platelet turnover (reticulated platelet count [RPC], mean platelet volume [MPV]) and function on long-term MACE, a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. Results: In total, 477 patients were eligible. Mean age was 64.3 ± 12.7 years, 68.8% were male. Median follow-up was 5.8 (IQR 4.2-6.5) years. Median RPC was 7.6 (IQR 5.6-10.4) g/L and median MPV was 10.7 (IQR 10.1-11.3) fL. In univariable analysis, RPC was associated with MACE, both as continuous (HR 1.064 [95%CI 1.021-1.111]; P = .006) and dichotomized (HR 1.693 [95%CI 1.156-2.481]; P = .006) variable. After adjustment, continuous RPC (HR 1.055 [95%CI 1.012-1.099]; P = .010) and dichotomized RPC (HR 1.716 [95%CI 1.152-2.559]; P = .007) remained significantly associated with MACE. Neither MPV nor platelet function testing was associated with long-term adverse outcome.

The Prognostic Value of Reticulated Platelets in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis

“…Included studies involved a total of 1,636 patients with CAD with 294 outcome events during follow-up. Four of the included studies took place in Europe (26)(27)(28)(29), and the remaining two studies were conducted in Iran (30) and the USA (31), respectively. All studies used the prospective cohort study design.…”

“…The earliest study (31) had a sample size of 51-100 people, and the rest of the studies in the following years had >100 people (26)(27)(28)(29)(30). Three studies included patients that underwent post-percutaneous coronary intervention (PCI) (26,27,29), one study included stable coronary artery disease (SCAD) combined with diabetes mellitus (DM) as the type of case (30), one study included patients hospitalized with acute coronary syndrome (ACS) (28), and the last one included patients with CAD patients (31). All included studies used the Sysmex XE-2100 automated hematology system to measure RPs, whose results would be expressed as IPF% or IPC.…”

“…All included studies used the Sysmex XE-2100 automated hematology system to measure RPs, whose results would be expressed as IPF% or IPC. Four studies reported IPF% (27)(28)(29)(30), and two studies reported IPC (26,31). The median of follow-up varied from the in-hospital admission to 5.8 years.…”

“…The proportion of female, smoker, and patients with hypertension, diabetes mellitus, and dyslipidemia are 30.6, 36.6, 75.3, 34.3, and 68.8%, respectively. Four studies only enrolled patients taking dual antiplatelet medications (26,27,29,31). One study only enrolled patients treated with a single antiplatelet agent-aspirin or clopidogrel (30).…”

“…Two studies indicated moderate quality (28,31), and the remaining four studies were rated as high quality (26,27,29,30). For the study confounding part, all included studies have adjusted at least one of predefined a priori into the multivariable analysis.…”