title: Platelet counts on admission affect coronary flow, myocardial perfusion and left ventricular systolic function after primary percutaneous coronary intervention.
abstract: BACKGROUND
  Patients with acute ST-elevation myocardial infarction (STEMI) and increased platelet count treated by fibrinolysis have worse outcomes.
  
  
  OBJECTIVE
  The aim of this study was to test the hypothesis that platelet blood count at admission in patients with acute STEMI treated by primary percutaneous coronary intervention affects coronary flow, myocardial perfusion and recovery of left ventricular systolic function.
  
  
  METHODS
  A total of 174 patients presenting with acute anterior STEMI and treated with primary percutaneous coronary intervention were included and divided into subgroups of admission platelet blood count of <200 K, 200-300 K, 300-400 K and >400 K. Evaluation of coronary artery flow and myocardial blush grade was performed according to the TIMI criteria. Electrocardiographic ST elevation resolution post-primary percutaneous coronary intervention was evaluated. Doppler echocardiographic evaluation of left anterior descending coronary artery velocities early and late after primary percutaneous coronary intervention and assessment of left ventricular ejection fraction and wall motion score index (WMSI) of left ventricular and left anterior descending coronary artery territory were performed.
  
  
  RESULTS
  Post-primary percutaneous coronary intervention TIMI, myocardial blush grade and ST elevation resolution were similar in all groups. Patients with platelet counts <200 K had higher peak diastolic left anterior descending coronary artery velocity both early and late after primary percutaneous coronary intervention, and higher prevalence of left anterior descending coronary artery velocity deceleration time exceeding 600 ms, (45.5% vs. 40%, P<0.05). Patients with platelet counts >400 K presented with worse left ventricular ejection fraction, left ventricular WMSI and left anterior descending coronary artery WMSI, and before discharge this subgroup had worse left ventricular WMSI and left anterior descending coronary artery WMSI, P<0.01.
  
  
  CONCLUSIONS
  Patients with anterior STEMI treated by primary percutaneous coronary intervention with lower admission platelet count had higher left anterior descending coronary artery diastolic velocities, better myocardial perfusion with more patients having left anterior descending coronary artery-descending coronary artery velocity deceleration time >600 ms. Patients with higher platelet counts had lower left ventricular systolic function both at admission and before discharge.
authors.affiliation: 1 Cardiology Department, Bnai Zion Medical Center, Israel.|2 Technion, Israel Institute of Technology Haifa, Israel.
authors.forename: Dawod
authors.initials: D
authors.lastname: Sharif
authors.affiliation: 2 Technion, Israel Institute of Technology Haifa, Israel.
authors.forename: Mira
authors.initials: M
authors.lastname: Abu-Salem
authors.affiliation: 2 Technion, Israel Institute of Technology Haifa, Israel.|3 Department of Mathematics, The Academic Arab College, Israel.
authors.forename: Amal
authors.initials: A
authors.lastname: Sharif-Rasslan
authors.affiliation: 1 Cardiology Department, Bnai Zion Medical Center, Israel.|2 Technion, Israel Institute of Technology Haifa, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Rosenschein
mesh_terms: D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010976:Platelet Count; D011184:Postoperative Period; D020127:Recovery of Function / Q000502:physiology*; D000072657:ST Elevation Myocardial Infarction / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D013599:Systole; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Acute anterior STEMI; Doppler echocardiography; coronary artery flow; left ventricular systolic function; platelet count; primary coronary angioplasty