血小板衍生的血栓形成通过在接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者中的总血栓形成分析系统进行测量。
Platelet-Derived Thrombogenicity Measured by Total Thrombus-Formation Analysis System in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.
机构信息
Division of Cardiology, Yokohama City University Medical Center.
Advanced Critical Care and Emergency Center, Yokohama City University Medical Center.
出版信息
Circ J. 2020 May 25;84(6):975-984. doi: 10.1253/circj.CJ-19-1043. Epub 2020 Mar 19.
BACKGROUND
Prompt and potent antiplatelet effects are important aspects of management of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). We evaluated the association between platelet-derived thrombogenicity during PPCI and enzymatic infarct size in STEMI patients.
METHODS AND RESULTS
Platelet-derived thrombogenicity was assessed in 127 STEMI patients undergoing PPCI by: (1) the area under the flow-pressure curve for the PL-chip (PL-AUC) using the total thrombus-formation analysis system (T-TAS); and (2) P2Yreaction units (PRU) using the VerifyNow system. Patients were divided into 2 groups (High and Low) based on median PL-AUCduring PPCI. PRU levels during PPCI were suboptimal in both the High and Low PL-AUCgroups (median [interquartile range] 266 [231-311] vs. 272 [217-317], respectively; P=0.95). The percentage of final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was lower in the High PL-AUCgroup (75% vs. 90%; P=0.021), whereas corrected TIMI frame count (31.3±2.5 vs. 21.0±2.6; P=0.005) and the incidence of slow-flow/no-reflow phenomenon (31% vs. 11%, P=0.0055) were higher. The area under the curve for creatine kinase (AUC) was greater in the High PL-AUCgroup (95,231±7,275 IU/L h vs. 62,239±7,333 IU/L h; P=0.0018). Multivariate regression analysis identified high PL-AUCduring PPCI (β=0.29, P=0.0006) and poor initial TIMI flow (β=0.37, P<0.0001) as independent determinants of AUC.
CONCLUSIONS
T-TAS-based high platelet-derived thrombogenicity during PPCI was associated with enzymatic infarct size in patients with STEMI.
背景
ST 段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（PPCI）时，迅速且强效的抗血小板作用非常重要。我们评估了 PPCI 期间血小板源性血栓形成与 STEMI 患者酶性梗死面积之间的关系。
方法和结果
通过：（1）使用血栓形成总分析系统（T-TAS）评估 PL 芯片的压力-面积曲线下面积（PL-AUC）；（2）使用 VerifyNow 系统评估 P2Y 反应单位（PRU），对 127 例接受 PPCI 的 STEMI 患者的血小板源性血栓形成进行评估。根据 PPCI 期间 PL-AUC 的中位数，将患者分为 2 组（高和低）。在高和低 PL-AUC 组中，PPCI 期间的 PRU 水平均不理想（中位数[四分位间距]分别为 266[231-311]和 272[217-317]；P=0.95）。高 PL-AUC 组的最终心肌梗死溶栓治疗（TIMI）3 级血流比例较低（75%比 90%；P=0.021），校正 TIMI 帧数（31.3±2.5 比 21.0±2.6；P=0.005）和慢血流/无复流现象的发生率（31%比 11%；P=0.0055）较高。高 PL-AUC 组的肌酸激酶曲线下面积（AUC）较大（95,231±7,275IU/L h 比 62,239±7,333IU/L h；P=0.0018）。多变量回归分析确定 PPCI 期间的高 PL-AUC（β=0.29，P=0.0006）和初始 TIMI 血流不良（β=0.37，P<0.0001）是 AUC 的独立决定因素。
结论
PPCI 期间 T-TAS 检测到的高血小板源性血栓形成与 STEMI 患者的酶性梗死面积相关。
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