Medizinische Klinik III, Kardiologie Und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany.
Clin Res Cardiol. 2010 Apr;99(4):227-33. doi: 10.1007/s00392-009-0109-y. Epub 2010 Jan 5.
Platelets play a critical role in arterial thrombosis, acute coronary syndrome (ACS) and stroke. Platelet collagen receptor glycoprotein VI (GPVI) is associated with acute coronary events and a poor clinical outcome.
Between January 2006 and March 2009, we evaluated 2,213 consecutive patients in a prospective study design, who presented with chest pain. Among 1,819 patients (82.2%) who underwent coronary angiography, 1,652 patients (90.8%) showed a coronary and 167 patients (9.2%) a non-coronary origin of chest pain. 901 patients (54.5%) presented with an ACS, 751 (45.5%) with a stable angina pectoris. Clinical outcome was performed by a predefined structured telephone interview after a 3-month follow-up (92.8%:1,533 of 1,652 patients).
Kaplan-Meier analysis for cumulative event-free survival revealed that patients with a elevated baseline GPVI expression had a poorer clinical outcome for cardiovascular death than patients with decreased GPVI levels (log rank; P = 0.040). These results were paralleled in composite cumulative survival that included myocardial infarction, stroke, and cardiovascular death (log rank; P = 0.002). Relative risk of cardiovascular death was found at 1.41 (95% CI 1.08-1.85) for platelet GPVI, 1.64 (95% CI 1.31-2.05) for brain natriuretic peptide, 1.16 (95% CI 0.81-1.64) for troponin-I and 1.33 (95% CI 0.97-1.82) for C-reactive protein.
Patients with CAD presenting increased levels of platelet GPVI had a poorer outcome and may profit from a dual antiplatelet therapy. Thus, GPVI may be a useful prognostic tool for adverse cardiovascular events. Future studies should substantiate GPVI for its potential role of risk prediction and consider its prognostic value to improve risk stratification.
血小板在动脉血栓形成、急性冠状动脉综合征（ACS）和中风中起着关键作用。血小板胶原受体糖蛋白 VI（GPVI）与急性冠状动脉事件和不良临床结局相关。
在 2006 年 1 月至 2009 年 3 月期间，我们对 2213 例连续胸痛患者进行了前瞻性研究设计评估。在 1819 例接受冠状动脉造影的患者中，1652 例（90.8%）显示冠状动脉病变，167 例（9.2%）显示非冠状动脉病变。901 例（54.5%）为 ACS，751 例（45.5%）为稳定型心绞痛。通过 3 个月的随访后进行预设的结构化电话访谈进行临床结局评估（92.8%：1652 例患者中有 1533 例）。
累积无事件生存的 Kaplan-Meier 分析显示，基线 GPVI 表达升高的患者心血管死亡的临床结局较差，而 GPVI 水平降低的患者则较好（对数秩检验；P=0.040）。这一结果在包括心肌梗死、中风和心血管死亡的复合累积生存率中得到了印证（对数秩检验；P=0.002）。心血管死亡的相对风险为血小板 GPVI 为 1.41（95%可信区间 1.08-1.85），脑利钠肽为 1.64（95%可信区间 1.31-2.05），肌钙蛋白 I 为 1.16（95%可信区间 0.81-1.64），C 反应蛋白为 1.33（95%可信区间 0.97-1.82）。
患有 CAD 的患者出现血小板 GPVI 水平升高时，结局较差，可能受益于双重抗血小板治疗。因此，GPVI 可能是一种有用的预测不良心血管事件的预后工具。未来的研究应证实 GPVI 对预测风险的潜在作用，并考虑其预后价值以改善风险分层。
