title: The relationship between platelet reactivity and infarct-related artery patency in patients presenting with a ST-elevation myocardial infarction.
abstract: Both heightened platelet reactivity and an occluded infarct related artery (IRA) on initial angiography and at the time of primary percutaneous coronary intervention (PCI) are associated with a worsened clinical outcome in patients with ST-elevation myocardial infarction (STEMI). However, the relationship between platelet reactivity and IRA patency has not yet been established. Consecutive STEMI-patients were enrolled in this study. Patients who had TIMI-flow (thrombolysis in myocardial infarction) 0 or 1 on initial angiography constituted the occluded IRA group and patients having TIMI-flow 2 or 3 comprised the IRA patent group. Platelet function measurements were performed using the PFA-100 COL/ADP cartridge and light transmittance aggregometry without agonist (spontaneous) and after stimulation with adenosine diphosphate (ADP) and arachidonic acid (AA). Ninety-nine patients were enrolled, of whom 49 presented with an occluded IRA. Multivariate analysis identified the following independent factors to be associated with an occluded IRA; short COL/ADP closure time (ORper quartile increase=0.60; 95% CI, 0.39-.93; p=0.02), the 20 μM ADP-induced light transmittance aggregometry (ORper quartile increase =1.77; 95% CI, 1.15-2.73; p=0.01) and leukocyte counts (odds ratio [OR]=1.21; 95% CI, 1.05-1.39; p = 0.008). In conclusion, heightened platelet reactivity and elevated leukocyte counts are associated with an occluded IRA upon presentation in STEMI-patients. These results emphasise the importance of potent antithrombotic therapy early after the onset of symptoms, to obtain early recanalisation of the IRA.
authors.affiliation: St. Antonius Center for Platelet Function Research, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Nicoline J
authors.initials: NJ
authors.lastname: Breet
authors.forename: Jochem W
authors.initials: JW
authors.lastname: van Werkum
authors.forename: Heleen J
authors.initials: HJ
authors.lastname: Bouman
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: Christian M
authors.initials: CM
authors.lastname: Hackeng
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: ten Berg
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016718:Arachidonic Acid / Q000494:pharmacology; D015331:Cohort Studies; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D015539:Platelet Activation / Q000187:drug effects; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D016718:Arachidonic Acid; D000244:Adenosine Diphosphate