Influence of platelet reactivity and inflammation on peri-procedural myonecrosis in East Asian patients undergoing elective percutaneous coronary intervention.

BACKGROUND AND OBJECTIVES: The contribution of multiple risk factors to peri-procedural myocardial infarction (PMI) in East Asians remains controversial. To assess the influence of clinical or laboratory covariates on PMI in these patients. METHODS: Stable patients (n=341) undergoing elective percutaneous coronary intervention (PCI) were enrolled. Platelet reactivity was measured by conventional aggregometry and VerifyNow. Inflammation markers and lipid profile were determined by standard methods. PMI was defined according to Universal definition (troponin I or CK-MB ≥ 3 times the 99th percentile of the upper reference limit). RESULTS: PMI (defined by troponin I and CK-MB) occurred in 47 (13.8%) and 30 (8.8%) patients, respectively. There was no significant difference in ADP-induced platelet reactivity between patients with vs. without PMI. Patients with PMI (troponin I) had higher levels of 6 μg/mL collagen-induced platelet aggregation (PA) and VerifyNow 'BASE' compared with those without PMI. The combination of '6 μg/mL collagen-induced PA>40%'+'BASE>318' (odds ratio, 14.08; 95% confidence intervals, 1.68 to 111.11; p=0.015) or 'WBC>6550/mm(3)'+'C-reactive protein>2.3mg/L' (odds ratio, 7.75; 95% confidence intervals, 2.49 to 24.39; p<0.001) was associated with an increased risk of PMI (troponin I). The greatest likelihood ratio was observed when cholesterol, inflammation marker and platelet function were combined together. CONCLUSION: This is the first study to demonstrate that heightened platelet responsiveness to collagen and thrombin may be a risk factor for myonecrosis in patients undergoing elective PCI. The utility of the combining measures of platelet function, inflammation and cholesterol to enhance risk stratification and thus facilitate personalized therapy deserves further study.

Duke Scholars

Author Paul Alfred Gurbel Medicine, Clinical Pharmacology