Global platelet hyperreactivity and elevated C-reactive protein levels predict long term mortality in STEMI patients

Rossella Marcucci, Serafina Valente, Anna Maria Gori, Marco Chiostri, Rita Paniccia, Betti Giusti, Vanessa Cau, Chiara Lazzeri, Gian Franco Gensini, Rosanna Abbate

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Data on long term - more than 1-year - prognostic value of global platelet reactivity (G-HPR) - by adenosine diphosphate (ADP) and arachidonic acid (AA) - in patients with STEMI undergoing PCI are limited. High C-reactive protein (CRP) levels have been suggested to be associated with post-PCI atherothrombotic events. Our aim was to evaluate the long-term prognostic impact of G-HPR and CRP levels in STEMI patients. Methods and Results: We evaluated 494 STEMI patients (366 M/128 F; age: 65.8 ± 12.4 yrs) undergoing PCI with stent implantation. At a median follow-up of 2.3 years (1.09-4.06), in 58 patients we documented cardiovascular death (11.7%). Platelet reactivity was assessed by light transmission aggregometry by 1 mM AA (AA-LTA) and 10 microM ADP (ADP-LTA). By the ROC curve analysis, 17%, 52% and 12 mg/L were found to be the values of AA-LTA, ADP-LTA and CRP associated with the highest specificity and sensitivity for death. G-HPR was defined as the presence of both AA-LTA ≥ 17% and ADP-LTA ≥ 52%. At Cox regression analysis adjusted for age, sex, cardiovascular risk factors, multivessel disease, ejection fraction, renal insufficiency, G-HPR and elevated CRP levels were associated with long-term mortality [HR = 1.78 (95%CI 1.04-3.03), p = 0.036 and HR = 2.91 (1.54-5.52, p = 0.001), respectively]. The contemporary presence of G-HPR and elevated CRP levels was associated with the highest risk of death [HR = 5.1 (95%CI 1.9-13.4), p = 0.001]. Conclusion: G-HPR and CRP are independent long-term prognostic markers in STEMI patients. The contemporary presence of G-HPR and CRP identifies a subgroup of patients at significantly higher risk of cardiovascular death.

Original languageEnglish
Pages (from-to)884-888
Number of pages5
JournalThrombosis Research
Volume134
Issue number4
DOIs
Publication statusPublished - Oct 1 2014

Keywords

  • Acute coronary syndromes
  • C-Reactive
  • Platelet hyperreactivity
  • Protein
  • STEMI patients

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

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