Zheng K L, Bor W L, Vernooij L M, Breet N C, Kelder J C, Hackeng C M, Kropman R H J, Ten Berg J M, Noordzij P G
Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Medical Centre, Utrecht, the Netherlands.
Thromb Res. 2022 Oct;218:177-185. doi: 10.1016/j.thromres.2022.08.023. Epub 2022 Aug 28.
Postoperative myocardial injury (PMI) after major vascular surgery, detected by elevated cardiac troponin (cTn), has been associated with morbidity and mortality. It is unclear whether the pathophysiology of PMI is determined by increased platelet activity.
To examine the relationship between platelet activation (P-selectin expression) and PMI in patients undergoing elective open abdominal aortic surgery.
This prospective, single-centre, observational, cohort study included 33 patients undergoing elective open abdominal aortic surgery between March 2018 and April 2021. Patients were routinely treated with aspirin. Unstimulated platelet activation was measured by platelet bound P-selectin expression (range 0-100 %). Explorative coagulation measurements were: stimulated platelet aggregation measured with the VerifyNow® assay (aspirin cartridge), with the Multiplate® analyzer (ASPI, ADP and TRAP) and stimulated coagulation status evaluated by the TEG® Hemostasis Analyzer System (global hemostasis cartridge). The primary outcome was cTn release assessed by the fifth generation high-sensitive cTn assay. Multivariable generalized linear mixed models were used to evaluate the association between platelet function and cTn concentrations over time.
Ten patients (30.3 %) developed PMI. Increased P-selectin expression directly after surgery was associated with the cTn concentrations over 48 h (β = 1.39 (1.1-1.75), P = 0.0064). No association was found between P-selectin measured later after surgery (at 24 h or 48 h) and cTn concentrations. Furthermore, there was no association between the explorative coagulation parameters and cTn release.
Platelet reactivity, assessed by P-selectin expression measured directly after surgery is associated with PMI, assessed by elevated cTn concentrations in the early postoperative period in patients undergoing elective open abdominal aortic surgery.
通过心脏肌钙蛋白（cTn）升高检测到的大血管手术后的术后心肌损伤（PMI）与发病率和死亡率相关。目前尚不清楚PMI的病理生理学是否由血小板活性增加所决定。
研究择期开放性腹主动脉手术患者血小板活化（P-选择素表达）与PMI之间的关系。
这项前瞻性、单中心、观察性队列研究纳入了2018年3月至2021年4月期间接受择期开放性腹主动脉手术的33例患者。患者常规接受阿司匹林治疗。通过血小板结合P-选择素表达（范围0-100%）测量未刺激的血小板活化。探索性凝血测量包括：使用VerifyNow®检测法（阿司匹林检测盒）、Multiplate®分析仪（ASPI、ADP和TRAP）测量刺激后的血小板聚集，并通过TEG®止血分析仪系统（整体止血检测盒）评估刺激后的凝血状态。主要结局是通过第五代高敏cTn检测评估的cTn释放。使用多变量广义线性混合模型评估血小板功能与cTn浓度随时间的关联。
10例患者（30.3%）发生了PMI。术后直接增加的P-选择素表达与48小时内的cTn浓度相关（β = 1.39（1.1-1.75），P = 0.0064）。在术后较晚时间（24小时或48小时）测量的P-选择素与cTn浓度之间未发现关联。此外，探索性凝血参数与cTn释放之间也没有关联。
在接受择期开放性腹主动脉手术的患者中，通过术后直接测量的P-选择素表达评估的血小板反应性与通过术后早期cTn浓度升高评估的PMI相关。
