title: Role of activation-dependent platelet membrane glycoproteins in development of subacute occlusive coronary stent thrombosis.
abstract: BACKGROUND
  Platelets have an important role in coronary thrombosis.
  
  
  METHODS
  We studied 151 consecutive patients undergoing implantation of Palmaz-Schatz stents because of suboptimal results after coronary balloon angioplasty treated by intense anticoagulation. Surface exposure of the constitutively expressed glycoprotein complex IIb-IIIa (CD41), P-selectin (CD62P) and of the GPIIb-IIIa complex activated exposure (of ligand-induced binding site-1) were determined, in addition to platelet count and plasma fibrinogen, before and daily for 12 days after stenting in peripheral venous blood samples.
  
  
  RESULTS
  Six of 151 patients (3.9%) developed subacute stent thrombosis within the first week after stenting. The relative risk of stent thrombosis was 18.5-fold for patients with enhanced GPIIb-IIIa surface expression (P < 0.003; 95% confidence interval 2.1 to 163.1) before stent placement. In the period after stenting, platelet activation occurred, with an increase in fibrinogen receptor activity and P-selectin degranulation above pre-stent values (P < 0.01). In logistic regression analysis, GPIIb-IIIa before stenting emerged as a risk factor for stent thrombosis, independent of the activational status of platelets, platelet count or fibrinogen levels (P < 0.02). However, after stenting, P-selectin surface expression acquired prognostic importance for stent thrombosis (P < 0.05).
  
  
  CONCLUSIONS
  We conclude that changes in platelet membrane glycoproteins are of prognostic value in predicting subacute stent thrombosis.
authors.affiliation: Medizinische Klinik, Techniechen Universität München, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gawaz
authors.forename: F J
authors.initials: FJ
authors.lastname: Neumann
authors.forename: I
authors.initials: I
authors.lastname: Ott
authors.forename: A
authors.initials: A
authors.lastname: May
authors.forename: S
authors.initials: S
authors.lastname: Rüdiger
authors.forename: A
authors.initials: A
authors.lastname: Schömig
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D003327:Coronary Disease / Q000628:therapy; D003328:Coronary Thrombosis / Q000097:blood / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000097:blood / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000096:biosynthesis / Q000097:blood; D015539:Platelet Activation / Q000502:physiology*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000096:biosynthesis / Q000378:metabolism / Q000502:physiology*; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*
chemical_list: D019007:P-Selectin; D019039:Platelet Glycoprotein GPIIb-IIIa Complex