网状血小板预测冠心病患者心血管死亡和不良事件：系统评价和荟萃分析。

Reticulated Platelets Predict Cardiovascular Death and Adverse Events in Coronary Artery Disease: A Systematic Review and Meta-analysis.

机构信息

Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany.

Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy.

出版信息

Thromb Haemost. 2024 Apr;124(4):310-319. doi: 10.1055/s-0043-1773763. Epub 2023 Sep 11.

DOI:10.1055/s-0043-1773763

PMID:37696301

Abstract

BACKGROUND

The pro-thrombotic immature or reticulated platelets (RPs) are known to be elevated in high-risk patients and in different pathological settings. It has been shown that RPs correlate with an insufficient antiplatelet response to antiplatelet agents. RPs are emerging novel predictors of adverse cardiovascular events in cardiovascular disease. This study, using the totality of existing evidence, evaluated the prognostic role of RPs in patients with coronary artery disease.

METHODS

We performed a systematic review and meta-analysis including trials of acute and chronic coronary syndrome reporting clinical outcomes according to RPs levels in the peripheral blood. We compared patients with elevated RPs (RPs) to patients without elevated RPs (RPs). Odds ratios (ORs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints were cardiovascular death, myocardial infarction, ischemic stroke, urgent coronary revascularization and bleedings.

RESULTS

A total of 7 studies, including 2213 patients, were included. The risk for MACCE was significantly higher in RPs compared to RPs patients (OR 2.67 [1.87; 3.81], = 43.8%). RPs were associated with cardiovascular death (OR 2.09 [1.36; 3.22], = 40.4%). No associations for RPs were detected with the other singular components of MACCE: myocardial infarction (OR 1.73 [0.89; 3.38] = 60.5%) and stroke (OR 1.72 [0.59; 4.96] = 21%). The risk of bleeding did not differ between groups(OR 0.58 [0.15; 2.22] = 86.1%).

CONCLUSION

Elevated RPs are significantly associated with increased risk of cardiovascular events and cardiovascular death.

摘要

背景

已知高风险患者和不同病理情况下存在促血栓形成的未成熟或网织血小板（RPs）升高。已经表明，RPs 与抗血小板药物的抗血小板反应不足相关。RPs 是心血管疾病中不良心血管事件的新兴新型预测因子。本研究使用现有证据的整体评估了 RPs 在冠状动脉疾病患者中的预后作用。

方法

我们进行了一项系统评价和荟萃分析，纳入了报告外周血中 RPs 水平的急性和慢性冠状动脉综合征试验，以评估 RPs 水平与临床结果之间的相关性。我们将 RPs 升高的患者（RPs 组）与 RPs 未升高的患者（RPs 组）进行比较。采用随机效应模型，比值比（OR）和 95%置信区间（CI）作为治疗效果的首选度量。主要终点是主要不良心血管和脑血管事件（MACCE）。次要终点是心血管死亡、心肌梗死、缺血性卒中和紧急冠状动脉血运重建和出血。

结果

共纳入 7 项研究，包括 2213 例患者。与 RPs 组相比，RPs 组发生 MACCE 的风险显著更高（OR 2.67 [1.87；3.81]，=43.8%）。RPs 与心血管死亡相关（OR 2.09 [1.36；3.22]，=40.4%）。RPs 与 MACCE 的其他单一成分（心肌梗死 OR 1.73 [0.89；3.38]，=60.5%和卒中和 OR 1.72 [0.59；4.96]，=21%）之间无相关性。两组之间的出血风险无差异（OR 0.58 [0.15；2.22]，=86.1%）。