Ly Hung Q, Kirtane Ajay J, Murphy Sabina A, Buros Jacki, Cannon Christopher P, Braunwald Eugene, Gibson C Michael
Cardiovascular Division, Brigham & Women's Hospital, Harvard School of Medicine, Boston, Massachusetts, USA.
Am J Cardiol. 2006 Jul 1;98(1):1-5. doi: 10.1016/j.amjcard.2006.01.046. Epub 2006 Apr 27.
Platelet activation and aggregation play pivotal roles in the thrombotic process of acute coronary syndromes. However, data regarding platelet count and its association with clinical outcomes in the setting of ST-elevation myocardial infarction (STEMI) are limited. We hypothesized that higher platelet counts on presentation would be associated with poorer clinical outcomes. Data from 10,793 patients with STEMI in the Thrombolysis In Myocardial Infarction (TIMI) trials database were analyzed. Mean platelet count on presentation was 254.8 x 10(3)/microl. Higher platelet counts were associated with higher rates of adverse clinical outcomes at 30 days. In a multivariable analysis that adjusted for confounders of platelet counts (age, gender, weight, diabetes, and smoking), higher platelet counts remained associated with an increased risk of the combined end point of death, reinfarction, and congestive heart failure. With a reference group of platelet counts <200 x 10(3)/microl, the multivariable odds ratios were 1.22 (95% confidence interval 1.05 to 1.42, p = 0.009) for platelet counts of 201 to 300 x 10(3)/microl, 1.37 (95% confidence interval 1.11 to 1.68, p = 0.002) for counts of 301 to 400 x 10(3)/microl, and 1.71 (95% confidence interval 1.16 to 2.51, p = 0.005) for counts >400 x 10(3)/microl. Further, a greater decrease in follow-up platelet counts (compared with baseline values) was independently associated with an increased risk of reinfarction at 30 days (odds ratio 1.44 for every decrease of 100 x 10(3)/microl unit of platelets, 95% confidence interval 1.13 to 1.82, p = 0.03). In conclusion, in STEMI, a higher platelet count on presentation was independently associated with adverse clinical outcomes, whereas a greater subsequent platelet count decrease was associated with an increased risk of reinfarction.
血小板活化和聚集在急性冠脉综合征的血栓形成过程中起关键作用。然而，关于血小板计数及其在ST段抬高型心肌梗死（STEMI）情况下与临床结局的关联的数据有限。我们推测，就诊时较高的血小板计数与较差的临床结局相关。对心肌梗死溶栓（TIMI）试验数据库中10793例STEMI患者的数据进行了分析。就诊时的平均血小板计数为254.8×10³/微升。较高的血小板计数与30天时不良临床结局的发生率较高相关。在一项针对血小板计数混杂因素（年龄、性别、体重、糖尿病和吸烟）进行调整的多变量分析中，较高的血小板计数仍然与死亡、再梗死和充血性心力衰竭联合终点的风险增加相关。以血小板计数<200×10³/微升的参考组为例，血小板计数为201至300×10³/微升时，多变量比值比为1.22（95%置信区间1.05至1.42，p = 0.009）；计数为301至400×10³/微升时，比值比为1.37（95%置信区间1.11至1.68，p = 0.002）；计数>400×10³/微升时，比值比为1.71（95%置信区间1.16至2.51，p = 0.005）。此外，随访血小板计数（与基线值相比）下降幅度越大，与30天时再梗死风险增加独立相关（血小板每减少100×10³/微升单位，比值比为1.44，95%置信区间1.13至1.82，p = 0.03）。总之，在STEMI中，就诊时较高的血小板计数与不良临床结局独立相关，而随后血小板计数下降幅度越大与再梗死风险增加相关。
