3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.
Institute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria.
Eur J Clin Invest. 2019 Sep;49(9):e13157. doi: 10.1111/eci.13157. Epub 2019 Aug 19.
Increased platelet turnover and high platelet reactivity are associated with short-term major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) or stable coronary artery disease (SCAD). We investigated the impact of platelet turnover on long-term MACE.
Consecutive patients presenting with ACS or SCAD undergoing PCI between 2009 and 2010 were included. All patients received clopidogrel and aspirin as dual antithrombotic therapy regimen. Multivariable Cox proportional hazard models were applied to assess the prognostic impact of platelet turnover (reticulated platelet count [RPC], mean platelet volume [MPV]) and function on long-term MACE, a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke.
In total, 477 patients were eligible. Mean age was 64.3 ± 12.7 years, 68.8% were male. Median follow-up was 5.8 (IQR 4.2-6.5) years. Median RPC was 7.6 (IQR 5.6-10.4) g/L and median MPV was 10.7 (IQR 10.1-11.3) fL. In univariable analysis, RPC was associated with MACE, both as continuous (HR 1.064 [95%CI 1.021-1.111]; P = .006) and dichotomized (HR 1.693 [95%CI 1.156-2.481]; P = .006) variable. After adjustment, continuous RPC (HR 1.055 [95%CI 1.012-1.099]; P = .010) and dichotomized RPC (HR 1.716 [95%CI 1.152-2.559]; P = .007) remained significantly associated with MACE. Neither MPV nor platelet function testing was associated with long-term adverse outcome.
Increased platelet turnover is associated with long-term adverse outcome in patients with coronary artery disease undergoing PCI. Platelet turnover represents a new marker of atherothrombotic risk and might help to guide composition or duration of antiplatelet therapy.
血小板周转率增加和血小板反应性高与急性冠状动脉综合征（ACS）或稳定型冠状动脉疾病（SCAD）患者经皮冠状动脉介入治疗（PCI）后的短期主要不良心血管事件（MACE）有关。我们研究了血小板周转率对长期 MACE 的影响。
连续纳入 2009 年至 2010 年间接受 PCI 治疗的 ACS 或 SCAD 患者。所有患者均接受氯吡格雷和阿司匹林双联抗栓治疗。多变量 Cox 比例风险模型用于评估血小板周转率（网织血小板计数[RPC]、平均血小板体积[MPV]）和功能对长期 MACE（心血管死亡、非致死性心肌梗死和非致死性卒中的复合终点）的预后影响。
共纳入 477 例患者。平均年龄为 64.3±12.7 岁，68.8%为男性。中位随访时间为 5.8（IQR 4.2-6.5）年。中位数 RPC 为 7.6（IQR 5.6-10.4）g/L，中位数 MPV 为 10.7（IQR 10.1-11.3）fL。单变量分析中，RPC 与 MACE 相关，既呈连续变量（HR 1.064[95%CI 1.021-1.111]；P=0.006）也呈二分变量（HR 1.693[95%CI 1.156-2.481]；P=0.006）。调整后，连续 RPC（HR 1.055[95%CI 1.012-1.099]；P=0.010）和二分 RPC（HR 1.716[95%CI 1.152-2.559]；P=0.007）仍与 MACE 显著相关。MPV 或血小板功能检测均与长期不良结局无关。
在接受 PCI 治疗的冠状动脉疾病患者中，血小板周转率增加与长期不良结局相关。血小板周转率是动脉粥样硬化血栓形成风险的新标志物，可能有助于指导抗血小板治疗的组成或持续时间。
