Platelet Function Predicts Myocardial Damage in Patients With Acute Myocardial Infarction

Abstract

Background-Platelet activation is a hallmark of acute coronary syndromes. Numerous lines of evidence suggest a mechanistic link between von Willebrand factor or platelet hyperfunction and myocardial damage in patients with acute coronary syndromes. Thus, we assessed whether platelet function under high shear rates (collagen adenosine diphosphate closure times [CADP-CTs]) measured with the platelet function analyzer (PFA-100) may be enhanced in patients with myocardial infarction (MI) and whether it may predict the extent of myocardial damage as measured by creatine kinase (CK-MB) or troponin T (TnT) levels. Methods and Results-Patients with acute chest pain or symptoms suggestive of acute coronary syndromes (nϭ216) were prospectively examined at an emergency department. CADP-CT was significantly shorter in patients with MI, particularly in those with an ST-segment-elevation MI (STEMI) compared with the other patient groups (unstable angina, stable coronary artery disease, or controls). Furthermore, CADP-CT and collagen epinephrine-CT at presentation were independent predictors of myocardial damage as measured by CK-MB or TnT. Patients with MI whose CADP-CT values fell in the first quartile had 3-fold higher CK-MB and TnT levels than those in the fourth quartile. Conclusions-Patients with STEMI have significantly enhanced platelet function when measured under high shear rates.CADP-CT is an independent predictor of the severity of MI, as measured by markers of cardiac necrosis. Measurement of platelet function with the PFA-100 may help in the risk stratification of patients presenting with MI. (Circulation.

White blood cell count to mean platelet volume ratio: A novel and promising prognostic marker for ST-segment elevation myocardial infarction

“…White blood cells (WBCs) and platelets have potential roles in the pathogenesis of ST-segment elevation myocardial infarction (STEMI) [2,3]. Increased WBC count is associated with increased mortality in patients with STEMI [4].…”

A High-Throughput Biotin-Avidin-ELISA for Studying Expression of Platelet Membrane Glycoproteins and Its Clinical Application

“…P-selectin and GPIIb/IIIa levels on platelet in patients with AMI, ICH or DM are markedly higher than those in the controls (Shechter et al 2000;Frossard et al 2004;Naidech et al 2009). Using the BA-ELISA, we measured the expression levels of platelet membrane P-selectin and GPIIb/IIIa in patients with AMI, ICH, or DM and healthy donors, respectively.…”

“…Patients with acute myocardial infarction (AMI) (Frossard et al 2004), intracerebral hemorrhage (ICH) (Naidech et al 2009) or diabetes mellitus (DM) (Shechter et al 2000) had an increased expression of P-selectin and GPIIb/IIIa on platelet membrane surface. Previously, platelet surface GPs were measured on intact platelets in whole blood using flow cytometry (Michelson 1996), platelet membrane microparticles were assayed in cell-free plasma using gel electrophoresis (George et al 1986) and immunoradiometric assay (Wu et al 1993).…”

Does glycoprotein IIB/IIIA resistance exist?

“…Only recently, the relationship between the level of platelet aggregation inhibition by platelet inhibitors and clinical outcome in acute myocardial infarction became more clear. [1][2][3][4][5] High platelet reactivity was found in patients who experienced stent thrombosis, and patients with clopidogrel resistance were at increased risk of recurrent atherothrombotic events. 1,2 Furthermore, in ST-elevation myocardial infarction (STEMI) increased levels of platelet aggregation were found compared with unstable angina or control patients.…”

“…1,2 Furthermore, in ST-elevation myocardial infarction (STEMI) increased levels of platelet aggregation were found compared with unstable angina or control patients. 4 In a thrombolysis study, higher platelet receptor occupancy was coupled with better angiographic and electrocardiographic outcome. 3 Finally, in STEMI patients undergoing primary percutaneous intervention (PCI), higher levels of platelet aggregation inhibition by abciximab were recently found to be associated with better myocardial reperfusion.…”