Kaplan Sahin, Kaplan Safiye Tuba, Kiris Abdulkadir, Gedikli Omer
Department of Cardiology, KTU, Faculty of Medicine Trabzon, Turkey.
Department of Internal Medicine, Numune State Hospital Trabzon, Turkey.
Int J Clin Exp Med. 2014 Apr 15;7(4):1064-70. eCollection 2014.
The baseline platelet count (BPC) in patients with acute ST elevation myocardial infarction (STEMI) may reflect the baseline anjiografic finding and may also predic long-term outcomes after primary percutaneous coronary intervention (PPCI). Available data for the value of BPC in patients with STEMI treated with PPCI are still questionable. Therefore, we sought to determine the prognostic value of BPC for baseline angiographic finding and the impact of BPC on clinical outcomes of patients treating with PPCI. Blood sample for BPC was obtained on admission in 140 consecutive patients undergoing PPCI. Patients were divided 2 groups that group-1 (104 patients): TIMI flow-grade 0 and group-2 (36 patients): TIMI flow-grade 1-3. Follow-up was performed at 1-9 months. Baseline demographics were comparable, but, BPC was significantly higher in group-1 comparing 2 (293.7±59.8x10(9)/L vs. 237.7±50.9x10(9)/L, p<0.0001), pre-procedural lesion length longer in group-1 comparing 2 (13.6±3.6 mm vs. 11.4±3.9 mm, p:0.003). Distal embolization (19.0% vs. 0.0%, p:0.001), slow-flow (15.2% vs. 2.9%, p:0.033) were more common in group-1 and mean maximum troponin-I level (9.1±4.2 μg/L vs. 5.1±3.9 μg/L, p<0.0001) and mean maximum creatinin kinase (2077.6±1378.4 U/L vs. 1163.4±869.7 U/L, p:<0.0001) were higher in group-1. In-hospital and 30-days major cardiac adverse events (MACEs) (16.5% vs. 5.7%), p:0.14) were similarly in both groups, but, at 6-months target vessel revascularization (13.9% vs. 0.0%, p:0.017) and MACEs significantly higher in the group-1 (24.1% vs. 2.9%, p:0.013).
A higher BPC without any antithrombotic agent is a strongly predictor of total occlusion of IRA in STEMI treated with PPCI. And a higher BPC associated with poor clinical outcomes at 9-months. Apart from prognostic value, measuring of a BPC on admission may also provide further practical and therapeutic profits.
急性ST段抬高型心肌梗死（STEMI）患者的基线血小板计数（BPC）可能反映基线血管造影结果，也可能预测直接经皮冠状动脉介入治疗（PPCI）后的长期预后。关于PPCI治疗的STEMI患者BPC值的现有数据仍存在疑问。因此，我们试图确定BPC对基线血管造影结果的预后价值以及BPC对接受PPCI治疗患者临床结局的影响。在140例连续接受PPCI的患者入院时采集BPC血样。患者分为两组，第1组（104例患者）：TIMI血流0级，第2组（36例患者）：TIMI血流1 - 3级。随访时间为1 - 9个月。两组患者的基线人口统计学特征具有可比性，但第1组的BPC显著高于第2组（293.7±59.8×10⁹/L对237.7±50.9×10⁹/L，p<0.0001），第1组术前病变长度长于第2组（13.6±3.6 mm对11.4±3.9 mm，p:0.003）。第1组远端栓塞（19.0%对0.0%，p:0.001）、慢血流（15.2%对2.9%，p:0.033）更为常见，且第1组肌钙蛋白I平均最高水平（9.1±4.2 μg/L对5.1±3.9 μg/L，p<0.0001）和肌酸激酶平均最高水平（2077.6±1378.4 U/L对1163.4±869.7 U/L，p:<0.0001）更高。两组患者住院期间及30天主要心脏不良事件（MACEs）发生率相似（16.5%对5.7%，p:0.14），但在6个月时，第1组靶血管血运重建率显著高于第2组（13.9%对0.0%，p:0.017），第1组MACEs发生率也显著高于第2组（24.1%对2.9%，p:0.013）。
在接受PPCI治疗的STEMI患者中，未使用任何抗血栓药物时较高的BPC是IRA完全闭塞的强烈预测指标。较高的BPC与9个月时不良临床结局相关。除预后价值外，入院时检测BPC还可能带来更多实际的治疗益处。
