Verdoia Monica, Barbieri Lucia, Schaffer Alon, Cassetti Ettore, Di Giovine Gabriella, Bellomo Giorgio, Marino Paolo, Sinigaglia Fabiola, De Luca Giuseppe
Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy,
J Thromb Thrombolysis. 2014 Apr;37(3):345-52. doi: 10.1007/s11239-013-0954-4.
Periprocedural myocardial infarction (PMI) still occurs in a large amount of percutaneous coronary interventions (PCI), mainly due to increased platelet activation. Platelet size has been suggested as an indicator of enhanced reactivity and platelet distribution width (PDW) could reflect morphologic changes in platelets, therefore affecting their function and potentially increasing the risk of complications after coronary stenting. Aim of the present study was to evaluate the relationship between PDW and PMI. We included 1,300 consecutive patients undergoing PCI. Myonecrosis biomarkers were dosed at intervals from 6 to 48 h after PCI. Periprocedural myonecrosis was defined as troponin I increase by three times the ULN or by 50 % of an elevated baseline value, whereas PMI as CKMB increase by three times the ULN or 50 % of baseline. We grouped patients according to tertiles values of PDW (<12.1; ≥13.9). Higher PDW was associated with age (p = 0.03), diabetes (p < 0.001), previous cerebrovascular accidents (p = 0.04), therapy with statins (p = 0.001) and ARBs (p < 0.001), ASA (p = 0.02), nitrates (p = 0.006), calcium antagonists (p = 0.05) and lower pre-procedural clopidogrel bolus (p = 0.005). PDW related with haemoglobin levels (p < 0.001), while inversely to platelet count (p < 0.001) and glycaemia (p = 0.003). Patients with larger PDW had lower presence of coronary thrombus (p < 0.001), higher rate of coronary calcifications (p = 0.02), higher stenting rate (p = 0.03) and lower rate of distal embolization (p = 0.03). Larger PDW did not increase risk of PMI (p = 0.11; adjusted OR [95 % CI] = 0.94 [0.78-1.1], p = 0.55) or periprocedural myonecrosis (p = 0.73; adjusted OR [95 % CI] = 0.95 [0.82-1.1], p = 0.51). Results were confirmed even in higher-risk subgroups of patients. In patients undergoing coronary stenting, PDW does not increase the risk of periprocedural MI and therefore should not be considered a risk factor for thrombotic periprocedural complications after PCI.
围手术期心肌梗死（PMI）在大量经皮冠状动脉介入治疗（PCI）中仍有发生，主要原因是血小板活化增加。血小板大小已被认为是反应性增强的指标，而血小板分布宽度（PDW）可反映血小板的形态变化，从而影响其功能，并可能增加冠状动脉支架置入术后并发症的风险。本研究的目的是评估PDW与PMI之间的关系。我们纳入了1300例连续接受PCI的患者。在PCI术后6至48小时内定期检测心肌坏死生物标志物。围手术期心肌坏死定义为肌钙蛋白I升高至正常上限（ULN）的三倍或高于基线值的50%，而PMI定义为肌酸激酶同工酶（CKMB）升高至ULN的三倍或基线值的50%。我们根据PDW的三分位数（<12.1；≥13.9）对患者进行分组。较高的PDW与年龄（p = 0.03）、糖尿病（p < 0.001）、既往脑血管意外（p = 0.04）、他汀类药物治疗（p = 0.001）、血管紧张素受体阻滞剂（ARB）治疗（p < 0.001）、阿司匹林（ASA）治疗（p = 0.02）、硝酸盐治疗（p = 0.006）、钙拮抗剂治疗（p = 0.05）以及术前氯吡格雷负荷剂量较低（p = 0.005）相关。PDW与血红蛋白水平相关（p < 0.001），而与血小板计数（p < 0.001）和血糖（p = 0.003）呈负相关。PDW较大的患者冠状动脉血栓形成的发生率较低（p < 0.001），冠状动脉钙化率较高（p = 0.02），支架置入率较高（p = 0.03），远端栓塞率较低（p = 0.03）。较大的PDW并未增加PMI的风险（p = 0.11；校正后的比值比[95%置信区间]= 0.94[0.78 - 1.1]，p = 0.55）或围手术期心肌坏死的风险（p = 0.73；校正后的比值比[95%置信区间]= 0.95[0.82 - 1.1]，p = 0.51）。即使在高危亚组患者中，结果也得到了证实。在接受冠状动脉支架置入的患者中，PDW不会增加围手术期心肌梗死的风险，因此不应被视为PCI术后血栓形成性围手术期并发症的危险因素。
