title: Low platelet activity predicts 30 days mortality in patients undergoing heart surgery.
abstract: Despite advanced techniques and improved clinical outcomes, patient survival following coronary artery bypass grafting (CABG) is still a major concern. Therefore, predicting future CABG mortality represents an unmet medical need and should be carefully explored. The objective of this study is to assess whether pre-CABG platelet activity corresponds with 30 days mortality post-CABG. Retrospective analyses of platelet biomarkers and death at 30 days in 478 heart surgery patients withdrawn from aspirin or/and clopidogrel. Platelet activity was assessed prior to CABG for aspirin (ASPI-test) with arachidonic acid and clopidogrel (ADP-test) utilizing Multiplate impedance aggregometer. Most patients (n = 198) underwent conventional CABG, off-pump (n = 162), minimally invasive (n = 30), artificial valve implantation (n = 48) or valves in combination with CABG (n = 40). There were 22 deaths at 30 days, including 10 in-hospital fatalities. With the cut-off value set below 407 area under curve (AUC) for the ASPI-test, the 30-day mortality was 5.90% for the lower cohort and 2.66% for patients with significantly higher platelet reactivity (P = 0.038). For the ADP-test with a cut-off at 400AUC, the 30-day mortality was 9.68% for the lower cohort and 3.66% for patients with higher platelet reactivity, representing a borderline significant difference (P = 0.046). Aside from the platelet indices, patients who received red blood cell (RBC) concentrate had a highly significant (P < 0.0001) risk of death at 30 days. Both aspirin and clopidogrel tests were useful in predicting 30 days mortality following heart surgery, suggesting the danger of diminished platelet activity prior to CABG in such high-risk patients. These preliminary evidence supports early discontinuation of antiplatelet therapy for elective CABG and requires adequately powered randomized trials to test the hypothesis and potentially improve survival.
authors.affiliation: aWroclaw Medical Academy, Wroclaw bSilesian Center for Heart Diseases, Zabrze, Poland cDepartment of Cardiology, Dong-A University Hospital, Busan, South Korea dJohns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Wiktor
authors.initials: W
authors.lastname: Kuliczkowski
authors.forename: Joanna
authors.initials: J
authors.lastname: Sliwka
authors.forename: Jacek
authors.initials: J
authors.lastname: Kaczmarski
authors.forename: Dorota
authors.initials: D
authors.lastname: Zysko
authors.forename: Michal
authors.initials: M
authors.lastname: Zembala
authors.forename: Dawid
authors.initials: D
authors.lastname: Steter
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.forename: Moo Hyun
authors.initials: MH
authors.lastname: Kim
authors.forename: Victor
authors.initials: V
authors.lastname: Serebruany
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology; D000368:Aged; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D016718:Arachidonic Acid / Q000494:pharmacology; D019540:Area Under Curve; D001241:Aspirin / Q000494:pharmacology; D001792:Blood Platelets / Q000187:drug effects* / Q000473:pathology; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D016718:Arachidonic Acid; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin