title: Global platelet hyperreactivity and elevated C-reactive protein levels predict long term mortality in STEMI patients.
abstract: BACKGROUND
  Data on long term - more than 1-year - prognostic value of global platelet reactivity (G-HPR) - by adenosine diphosphate (ADP) and arachidonic acid (AA) - in patients with STEMI undergoing PCI are limited. High C-reactive protein (CRP) levels have been suggested to be associated with post-PCI atherothrombotic events. Our aim was to evaluate the long-term prognostic impact of G-HPR and CRP levels in STEMI patients.
  
  
  RESULTS
  We evaluated 494 STEMI patients (366 M/128 F; age: 65.8 ± 12.4 yrs) undergoing PCI with stent implantation. At a median follow-up of 2.3 years (1.09-4.06), in 58 patients we documented cardiovascular death (11.7%). Platelet reactivity was assessed by light transmission aggregometry by 1mM AA (AA-LTA) and 10 microM ADP (ADP-LTA). By the ROC curve analysis, 17%, 52% and 12 mg/L were found to be the values of AA-LTA, ADP-LTA and CRP associated with the highest specificity and sensitivity for death. G-HPR was defined as the presence of both AA-LTA ≥ 17% and ADP-LTA ≥ 52%. At Cox regression analysis adjusted for age, sex, cardiovascular risk factors, multivessel disease, ejection fraction, renal insufficiency, G-HPR and elevated CRP levels were associated with long-term mortality [HR=1.78 (95%CI 1.04-3.03), p=0.036 and HR=2.91 (1.54-5.52, p=0.001), respectively]. The contemporary presence of G-HPR and elevated CRP levels was associated with the highest risk of death [HR=5.1 (95%CI 1.9-13.4), p=0.001].
  
  
  CONCLUSIONS
  G-HPR and CRP are independent long-term prognostic markers in STEMI patients. The contemporary presence of G-HPR and CRP identifies a subgroup of patients at significantly higher risk of cardiovascular death.
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy. Electronic address: rossella.marcucci@unifi.it.
authors.forename: Rossella
authors.initials: R
authors.lastname: Marcucci
authors.affiliation: Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy; Centro S.Maria agli Ulivi, Fondazione Don Carlo Gnocchi Onlus IRCCS, Impruneta, Florence, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Gori
authors.affiliation: Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Paniccia
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy.
authors.forename: Betti
authors.initials: B
authors.lastname: Giusti
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cau
authors.affiliation: Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy; Centro S.Maria agli Ulivi, Fondazione Don Carlo Gnocchi Onlus IRCCS, Impruneta, Florence, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Centre for the study at molecular and clinical level of chronic, degenerative and neoplastic diseases to develop novel therapies, University of Florence, Florence, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects / Q000473:pathology*; D002097:C-Reactive Protein / Q000032:analysis*; D000077144:Clopidogrel; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010979:Platelet Function Tests; D011379:Prognosis; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D002097:C-Reactive Protein; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Acute coronary syndromes; C-Reactive; Platelet hyperreactivity; Protein; STEMI patients