Jaster Markus, Horstkotte Dieter, Willich Tobias, Stellbaum Caroline, Knie Wulf, Spencker Sebastian, Pauschinger Mathias, Schultheiss Heinz-Peter, Rauch Ursula
Medical Clinic II, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Atherosclerosis. 2008 Mar;197(1):190-6. doi: 10.1016/j.atherosclerosis.2007.03.020. Epub 2007 May 7.
To determine the value of fibrinogen-positive platelet-analysis in predicting restenosis after stent implantation in acute myocardial infarction patients.
Our patient population comprised 50 patients who underwent intravascular ultrasound (IVUS) guided stent implantation for acute myocardial infarction. In all cases, IVUS confirmed a deep vessel wall injury due to a ruptured plaque within the culprit lesion. Flow cytometry quantified the amount of platelets with surface-bound fibrinogen and thrombospondin before and immediately after the intervention. After 5 months, IVUS was repeated to assess the long-term results. In-stent restenosis - defined as a percent diameter stenosis of >50% - was detected in 11 of 45 patients who attended follow-up angiography. The amount of fibrinogen-positive platelets was significantly higher among patients who subsequently developed in-stent restenosis (50.5+/-6.8% fibrinogen-positive platelets immediately after intervention) than among those who did not (39.7+/-12.3% fibrinogen-positive platelets, p<0.005). Receiver operating characteristic curve revealed a 40% cut-off for fibrinogen-positive platelets immediately after the intervention to predict restenosis (p<0.05, sensitivity: 90.9%, specificity: 47.1%).
The amount of fibrinogen-positive platelets immediately after stent implantation predicts the occurrence of in-stent restenosis, as confirmed by IVUS in acute myocardial infarction patients.
确定纤维蛋白原阳性血小板分析在预测急性心肌梗死患者支架植入术后再狭窄中的价值。
我们的患者群体包括50例接受血管内超声（IVUS）引导下急性心肌梗死支架植入术的患者。所有病例中，IVUS均证实罪犯病变内破裂斑块导致血管壁深层损伤。流式细胞术对干预前及干预后即刻表面结合有纤维蛋白原和血小板反应蛋白的血小板数量进行定量。5个月后，重复IVUS以评估长期结果。45例接受随访血管造影的患者中，11例检测到支架内再狭窄，定义为直径狭窄百分比>50%。随后发生支架内再狭窄的患者（干预后即刻纤维蛋白原阳性血小板为50.5±6.8%）中纤维蛋白原阳性血小板数量显著高于未发生再狭窄的患者（纤维蛋白原阳性血小板为39.7±12.3%，p<0.005）。受试者工作特征曲线显示，干预后即刻纤维蛋白原阳性血小板预测再狭窄的临界值为40%（p<0.05，敏感性：90.9%，特异性：47.1%）。
支架植入后即刻纤维蛋白原阳性血小板数量可预测急性心肌梗死患者支架内再狭窄的发生，这一结果经IVUS证实。
