1 Department of Cardiology, Hungarian Defence Forces, Hungary.
2 School of PhD studies, Semmelweis University, Hungary.
Eur J Prev Cardiol. 2017 Jul;24(11):1148-1156. doi: 10.1177/2047487317704937. Epub 2017 Apr 25.
Background Acute coronary syndrome is associated with platelet hyperactivity, which in its persistent form, promotes recurrent thrombotic events. Complex cardiac rehabilitation after acute coronary syndrome improves clinical outcome; however, its effect on platelet hyperactivity is unknown. Design and methods We enrolled 84 acute coronary syndrome patients on dual antiplatelet therapy, who underwent a new complex cardiac rehabilitation programme (NovaCord physiotherapy, lifestyle counselling, strict diet, stress management and regular coaching) and 51 control acute coronary syndrome patients with traditional cardiac rehabilitation. Platelet functionality was determined at enrolment and at three months follow-up by aggregometry, serum platelet-derived growth factor levels, total- and platelet-derived microvesicle counts (PMV; CD41a+/CD61+, CD62P+). Results Platelet aggregation parameters and platelet-derived growth factor levels were significantly decreased in the complex cardiac rehabilitation group at three months (1 µg/ml collagen, median (interquartile range): 22 (10-45) vs 14 (7.5-25.5)%, p = 0.0015; 2 µg/ml collagen: 36 (22-60) vs 26.5 (16-37)%, p = 0.0019; 1.25 µM adenosine-diphosphate: 4.5 (1-10) vs 1 (0-3)%, p = 0.0006; 5 µM adenosine-diphosphate: 27 (16-38) vs 22 (12-31)%, p = 0.0078; epinephrine: 33 (15-57) vs 27 (12-43)%, p = 0.01; platelet-derived growth factor: 434.6 (256.0-622.7) vs 224.8 (148.5-374.1) pg/ml, p = 0.0001). In contrast, these changes were absent or did not reach statistical significance in the traditional cardiac rehabilitation group. Platelet-derived microvesicle counts were significantly decreased in both groups, while total microvesicle count was significantly reduced only in the complex cardiac rehabilitation group (median (interquartile range): 3945.5 (2138-5661) vs 1739 (780-2303) count/µl; p = 0.0001). Conclusions Platelet hyperactivity three months after acute coronary syndrome significantly decreased in patients undergoing complex cardiac rehabilitation. Besides dual antiplatelet therapy, effective management and comprehensive control of cardiovascular risk factors might represent a new, non-pharmacological approach to influence platelet functionality.
背景 急性冠状动脉综合征与血小板活性亢进有关，其持续存在会促进复发性血栓事件。急性冠状动脉综合征后的复杂心脏康复可改善临床结局；然而，其对血小板活性亢进的影响尚不清楚。
设计和方法 我们纳入了 84 名正在接受双联抗血小板治疗的急性冠状动脉综合征患者，他们接受了新的复杂心脏康复计划（NovaCord 物理治疗、生活方式咨询、严格饮食、压力管理和定期指导），并将 51 名接受传统心脏康复的急性冠状动脉综合征对照患者纳入研究。在入组时和 3 个月随访时，通过聚集度测定、血清血小板衍生生长因子水平、总血小板衍生微泡计数（CD41a+/CD61+、CD62P+）和血小板衍生微泡计数（PMV；CD41a+/CD61+、CD62P+）来确定血小板功能。
结果 在 3 个月时，复杂心脏康复组的血小板聚集参数和血小板衍生生长因子水平显著降低（1μg/ml 胶原，中位数（四分位距）：22（10-45）%比 14（7.5-25.5）%，p=0.0015；2μg/ml 胶原：36（22-60）%比 26.5（16-37）%，p=0.0019；1.25μM 二磷酸腺苷：4.5（1-10）%比 1（0-3）%，p=0.0006；5μM 二磷酸腺苷：27（16-38）%比 22（12-31）%，p=0.0078；肾上腺素：33（15-57）%比 27（12-43）%，p=0.01；血小板衍生生长因子：434.6（256.0-622.7）pg/ml 比 224.8（148.5-374.1）pg/ml，p=0.0001）。相比之下，这些变化在传统心脏康复组中并不存在或未达到统计学意义。两组血小板衍生微泡计数均显著降低，而复杂心脏康复组的总微泡计数仅显著降低（中位数（四分位距）：3945.5（2138-5661）比 1739（780-2303）/µl；p=0.0001）。
结论 急性冠状动脉综合征后 3 个月时，接受复杂心脏康复的患者血小板活性亢进显著降低。除双联抗血小板治疗外，有效管理和综合控制心血管危险因素可能代表一种新的、非药物的影响血小板功能的方法。
