Marcucci Rossella, Paniccia Rita, Antonucci Emilia, Poli Serena, Gori Anna Maria, Valente Serafina, Giglioli Cristina, Lazzeri Chiara, Prisco Domenico, Abbate Rosanna, Gensini Gian Franco
Department of Heart and Vessels, Azienda Ospedaliero- Universitaria Careggi, Università degli Studi di Firenze, Viale Morgagni 85 50134 Florence, Italy. r.marcucci @dac.unifi.it
Thromb Haemost. 2007 Oct;98(4):844-51.
In this study we sought to evaluate if platelet function measured after percutaneous coronary intervention (PCI) affects the severity of myocardial infarction (MI), measured by markers of cardiac necrosis. We measured platelet function by both a point-of-care assay (PFA-100) and platelet-rich plasma aggregation by two agonists (arachidonic acid -AA- and 2 and 10 microM ADP) in 367 patients with MI after PCI (200 patients on dual antiplatelet agents - group A- and 167 on dual antiplatelet agents plus GpIIb/IIIa inhibitors - group B). One hundred twenty-one (32.9%) patients were found to have a residual platelet reactivity (RPR) by PFA (CT/EPI <203 sec): 74/200 (37%) in group A and 47/167 (28.1%) in group B (p = 0.07). In 129 (35.1%) patients we found a RPR by AA-PA: 80/200 (40%) in group A and 49/167 (29.3%) in group B (p < 0.05). Seventeen out of 367 (4.6%) were found to have a RPR by ADP2-PA [15/200 (7.5%) in group A and 2/167 (1.2%) in group B; p < 0.005] and 88/367 (23.9%) by ADP10-PA [64/200 (32%) in group A and 24/167 (14.4%) in group B, p < 0.0001]. CK-MB and cTnI mean peak values were significantly higher in the first tertile of CT/ADP and CT/EPI distribution with respect to the other tertiles and they were significantly higher in patients with RPR by CT/EPI in both group A and group B patients. CK-MB and cTnI peak values were significantly higher in the third tertile of AA-PA, ADP 2 microM-PA and ADP 10 microM-PA distribution with respect to the other tertiles and were significantly higher in patients with RPR by AA-PA and by ADP 10-PA in both group A and group B patients. Multivariate analysis revealed platelet function as an independent predictor of CK-MB and cTnI peak values in both groups of patients independently of clinical, laboratory ad procedural parameters. In conclusion, we found that the severity of MI in patients with MI undergoing primary PCI is influenced by a persistent platelet activation on multiple antiplatelet therapy.
在本研究中，我们试图评估经皮冠状动脉介入治疗（PCI）后所测血小板功能是否会影响通过心肌坏死标志物测得的心肌梗死（MI）的严重程度。我们采用即时检测法（PFA-100）以及通过两种激动剂（花生四烯酸 -AA- 和2及10微摩尔ADP）检测富含血小板血浆聚集情况，对367例PCI术后发生MI的患者进行血小板功能检测（200例服用双联抗血小板药物 - A组 - 和167例服用双联抗血小板药物加糖蛋白IIb/IIIa抑制剂 - B组）。通过PFA发现121例（32.9%）患者存在残余血小板反应性（RPR）（CT/EPI<203秒）：A组74/200例（37%），B组47/167例（28.1%）（p = 0.07）。通过AA-PA发现129例（35.1%）患者存在RPR：A组80/200例（40%），B组49/167例（29.3%）（p<0.05）。367例中有17例（4.6%）通过ADP2-PA检测存在RPR [A组15/200例（7.5%），B组2/167例（1.2%）；p<0.005]，88/367例（23.9%）通过ADP10-PA检测存在RPR [A组64/200例（32%），B组24/167例（14.4%），p<0.0001]。与其他三分位数相比，CT/ADP和CT/EPI分布的第一个三分位数中CK-MB和cTnI的平均峰值显著更高，并且A组和B组中通过CT/EPI检测存在RPR的患者中这些值也显著更高。与其他三分位数相比，AA-PA、ADP 2微摩尔-PA和ADP 10微摩尔-PA分布的第三个三分位数中CK-MB和cTnI峰值显著更高，并且A组和B组中通过AA-PA和ADP 10-PA检测存在RPR的患者中这些值也显著更高。多变量分析显示，在两组患者中，血小板功能是CK-MB和cTnI峰值的独立预测因素，与临床、实验室和手术参数无关。总之，我们发现接受直接PCI的MI患者中MI的严重程度受到多种抗血小板治疗中持续血小板激活的影响。
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