Impact of inflammatory markers on platelet inhibition and cardiovascular outcome including stent thrombosis in patients with symptomatic coronary artery disease.
BACKGROUND
There is cumulative evidence that the degree of inflammation correlates with prognosis after percutaneous coronary interventions (PCI). Additionally, there is a cross-link between platelet activation and inflammatory pathways. The aim of the present analysis was to evaluate the association of inflammatory markers and effects of dual antiplatelet therapy on platelet function and outcome in patients undergoing PCI.


RESULTS
In a pilot study, 157 patients with symptomatic coronary artery disease (CAD) undergoing PCI were consecutively evaluated. Platelet response to clopidogrel and acetylsalicylic acid was assessed using whole blood multiple electrode aggregometry (MEA). Baseline levels of IL-6, RANTES and MCP-1 were measured by Bio-Plex Cytokine assay. C-reactive protein (CRP) was determined by Immunoassay. Levels of IL-6, RANTES, and CRP correlated well with ADP and arachidonic acid (AA)-induced MEA. In a second step, a retrospective analysis of a cohort of 903 PCI-patients was performed to evaluate the association of on-treatment residual platelet aggregation (RPA) and baseline CRP levels on the incidence of myocardial infarction (MI), death and stent thrombosis (ST). Patients suffering a subsequent event had a significantly higher level of baseline CRP and higher RPA compared to patients without events. After multivariate adjustment high baseline CRP and high RPA were independent predictors for combined major events and ST after PCI.


CONCLUSIONS
To our knowledge this is the first study linking inflammation, antiplatelet drug responsiveness and outcome in a large CAD-patient cohort. The results suggest a relevant interaction of these parameters and encourage multimodal therapeutic approaches to treat cardiovascular risk after PCI.
Müller
Karin
K
Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität, Tübingen, Germany.
Aichele
Simon
S
Herkommer
Mario
M
Bigalke
Boris
B
Stellos
Konstantinos
K
Htun
Patrik
P
Fateh-Moghadam
Suzanne
S
May
Andreas E
AE
Flather
Marcus
M
Gawaz
Meinrad
M
Geisler
Tobias
T
D054058:Acute Coronary Syndrome / Q000378:metabolism; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods; D001241:Aspirin / Q000494:pharmacology; D001792:Blood Platelets / Q000166:cytology*; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000378:metabolism* / Q000628:therapy; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000378:metabolism* / Q000628:therapy; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D010865:Pilot Projects; D015539:Platelet Activation; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology; D016896:Treatment Outcome
D002097:C-Reactive Protein; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin