Platelet production regulation and dynamics of platelets functional activity in patients with ST segment elevation at myocardial infarction treated with double antiplatelet therapy

2019 ◽  
Author(s):  
Л.И. Малинова ◽  
П.В. Долотовская ◽  
Н.Ф. Пучиньян ◽  
Н.В. Фурман ◽  
Т.П. Денисова
Keyword(s):  
Myocardial Infarction ◽  
Platelet Count ◽  
Platelet Aggregation ◽  
Antiplatelet Therapy ◽  
Functional Activity ◽  
Relative Width ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
D Dimer

Введение. В ряде исследований продемонстрирована ассоциация доли молодых тромбоцитов с риском повторных тромботических событий у больных с острым коронарным синдром; однако взаимосвязь интенсивности тромбоцитогенеза и динамики функциональной активности тромбоцитов на фоне двойной антитромбоцитарной терапии (ДАТ) при острой необратимой ишемии и некробиозе миокарда остается малоизученной. Цель исследования: оценить особенности тромбоцитопоэза в сопоставлении с параметрами функциональной активности тромбоцитов на фоне ДАТ у больных инфарктом миокарда с подъемом сегмента ST (ИМпST). Материал и методы. У больных ИМпST (мужчины, n = 101) при поступлении, на 2-й и 7-й день госпитализации иммуноферментным методом определяли уровни тромбопоэтина, фактора стромальных клеток 1, тромбопоэтинового рецептора и Д-димера. Агрегационную активность тромбоцитов, секрецию плотных гранул, количество тромбоцитов, средний объем тромбоцита, относительную ширину распределения тромбоцитов по размеру оценивали при поступлении и на 7-е сутки. Результаты. В течение 7 дней на фоне ДАТ у 69,3% больных ИМпST происходил рост количества тромбоцитов — 270 [227; 279] × 109/л vs. 300 [265; 304] × 109/л (p = 0,007), что сопровождалось снижением коллаген-индуцированной агрегации тромбоцитов — 9,0 [7,0; 16,0] Ом vs. 6,5 [3,5; 8,5] Ом (p = 0,047). Направление и величина изменения количества тромбоцитов коррелировали с уровнем тромбопоэтина при поступлении (R = 0,656; p = 0,039). У пациентов с ИМпST с ростом количества тромбоцитов происходило увеличение уровня Д-димера — 302 [96; 812] нг/мл vs. 126 [94; 325] нг/мл (р = 0,048). Определены граничные условия относительной устойчивости системы тромбоцитогеза у больных ИМпST на фоне ДАТ: уровень тромбопоэтина — 180–310 пг/мл. Заключение. Полученные данные свидетельствуют о модификации регуляции тромбоцитогенеза у больных ИМпST на фоне ДАТ, однако клиническое значение этого нуждается в дополнительном изучении. Introduction. Several studies have demonstrated the association of young platelets amount with the risk of rethrombotic events in patients with acute coronary syndrome, but the relationship between intensity of thrombocytogenesis and the dynamics of platelet functional activity under double antiplatelet therapy (DAT) in acute irreversible ischemia and myocardium necrobiosis remains poorly understood. Aim: to assess the characteristics of thrombocytopoiesis in comparison with the parameters of functional platelets activity in patients with myocardial infarction with ST segment elevation (STеMI) and treated with DAT. Materials and methods. Thrombopoietin, stromal cell derived factor 1, thrombopoietin receptor and D-dimer levels were determined by the enzyme immunoassay method in 101 male patients with STеMI on admission, on the 2nd and 7th days of hospitalization. Platelet aggregation activity, dense granule secretion, platelet count, average platelet volume and relative width of platelet size distribution were assessed on admission and on 7th day. Results. Within 7 days under DAT in 69.3% of STеMI patients platelet count increased — 270 [227; 279] × 109/L vs. 300 [265, 304] × 109/L (p = 0.007) that was accompanied by reduction of collagen-induced platelet aggregation — 9.0 [7.0; 16.0] Om vs. 6.5 [3.5; 8.5] Om (p = 0.047). The direction and magnitude of platelet count change correlated with thrombopoietin level on admission (R = 0.656; p = 0.039). Together with platelet count rising in STеMI patients D-dimer level increased — 302 [96; 812] ng/ml vs. 126 [94; 325] ng/ml (p = 0.048). We identifi ed boundary conditions of the relative thrombocytogenesis stability in STеMI patients under DAT: thrombopoietin level — 180–310 pg/ml. Conclusion. Received data suggest a modifi cation of thrombocytogenesis regulation in STеMI patients treated with DAT; however, the clinical signifi cance of this observation requires further investigation.

scholarly journals Old and New Players in Oral Antiplatelet Therapy in Treatment of Acute Coronary Syndrome

1970 ◽  
Vol 1 (1) ◽  
pp. 49-55
Author(s):  
SC Kohli
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Antiplatelet Drugs ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Oral antiplatelet therapy plays an important role in treating patients with acute coronary syndrome (ACS), including patients with unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI) and patients with ST-segment elevation myocardial infarction (STEMI). All antiplatelet drugs in addition to inhibiting acute arterial thrombosis have danger of interfering with the physiologic role of platelet hemostasis. Bleeding is a major factor in evaluating the utility of available and upcoming antiplatelet drugs and their combination regimes. The role of anti platelet agents in the treatment of ACS has undergone significant changes over the past several years. Aspirin, thienopyridines, and glycoprotein (GP) IIb/IIIa inhibitors are now standard parts of the treatment of STEMI, NSTEMI and UA whether an early invasive or an initial conservative strategy is chosen. Antiplatelet drugs have an important role in secondary prevention in the patients of ischaemic heart disease. Keywords: Acute Coronary Syndrome; antiplatelet therapy; thienopyridines. DOI: http://dx.doi.org/10.3126/njms.v1i1.5799   Nepal Journal of Medical Sciences. 2012; 1(1): 49-55

scholarly journals Discordance Between VASP Phosphorylation and Platelet Aggregation in Defining High On-Clopidogrel Platelet Reactivity After ST-Segment Elevation Myocardial Infarction

2017 ◽  
Vol 24 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Jing Sun ◽  
Guo-Hong Yang ◽  
Jun-Xiang Liu ◽  
Xin-Lin Liu ◽  
Yong-Qiang Ma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Aggregation ◽  
Antiplatelet Therapy ◽  
Light Transmission ◽  
Platelet Reactivity ◽  
Reactivity Index ◽  
St Segment Elevation ◽  
Admission Time ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

To investigate potential clinical characteristics associated with discordance between platelet vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) flow cytometry (FCM) assay and light transmission aggregometry (LTA) in defining high on-clopidogrel platelet reactivity (HPR) after ST-segment elevation myocardial infarction (STEMI). In this study, platelet responsiveness was measured by the above 2 methods simultaneously on day 1 and on day 6 of STEMI onset in 90 consecutive patients who underwent primary percutaneous coronary intervention. The FCM-derived platelet reactivity index and LTA-derived platelet aggregation rate were both significantly reduced after dual antiplatelet therapy on day 6. Multiple variable-adjusted logistic regression analysis revealed that smoking (odds ratio [OR]: 4.507, 95% confidence interval [CI]: 1.123-18.09, P = .034) and onset-to-admission time (per 1 hour increase, OR: 1.196, 95% CI: 1.023-1.398, P = .025) both were independent predictors for the discordance between the 2 methods. Additionally, improved correlation and concordance was observed in nonsmokers compared with smokers. Our data show that smoking and prolonged onset-to-admission time are associated with discordance between platelet VASP-P and LTA in defining HPR after STEMI, which should be considered when planning personalized antiplatelet therapy.

Vorapaxar expands antiplatelet options

2012 ◽  
Vol 32 (03) ◽  
pp. 221-227 ◽  
Author(s):  
C. Bode ◽  
D. Duerschmied
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Arterial Disease ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Triple Antiplatelet Therapy ◽  
History Of ◽  
Peripheral Arterial ◽  
Ischemic Events

SummaryVorapaxar is the first substance of a new class of antiplatelet drugs that has been tested in large clinical trials. The protease-activated receptor 1 (PAR-1) antagonist inhibits thrombin-induced platelet activation to prevent atherothrombosis. In the phase 3 trials TRACER (acute coronary syndrome) and TRA 2P-TIMI 50 (stable atherosclerosis) reducing ischemic events with vorapaxar came at the cost of bleeding.TRACER compared vorapaxar to placebo in 12 944 patients who had non-ST-segment elevation acute coronary syndromes on top of contemporary treatment including dual antiplatelet therapy (aspirin and clopidogrel). Vorapaxar reduced ischemic events non-significantly, but increased bleeding significantly, therefore not justifying triple antiplatelet therapy in this setting. Follow-up was stopped early because of bleeding. TRA 2P-TIMI 50 examined 26 449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease. Vorapaxar reduced ischemic events and increased bleeding both significantly. Recruitment of patients with prior stroke was stopped early. Net clinical outcome and subgroup analyses suggested that vorapaxar could be beneficial for patients with prior myocardial infarction – but no history of stroke.

scholarly journals Survey of clinical practice pattern in Germany’s certified chest pain units

Herz ◽  
2021 ◽  
Author(s):  
Frank Breuckmann ◽  
Stephan Settelmeier ◽  
Tienush Rassaf ◽  
Felix Post ◽  
Winfried Haerer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Antiplatelet Therapy ◽  
Utilization Rate ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
The Impact ◽  
High Sensitive Troponin

Abstract Background We aimed to analyze the 2020 standard of care in certified German chest pain units (CPU) with a special focus on non-ST-segment elevation acute coronary syndrome (NSTE-ACS) through a voluntary survey obtained from all certified units, using a prespecified questionnaire. Methods The assessment included the collection of information on diagnostic protocols, risk assessment, management and treatment strategies in suspected NSTE-ACS, the timing of invasive therapy in non-ST-segment elevation myocardial infarction (NSTEMI), and the choice of antiplatelet therapy. Results The response rate was 75%. Among all CPUs, 77% are currently using the European Society of Cardiology (ESC) 0/3‑h high-sensitive troponin protocol, and only 20% use the ESC 0/1‑h high-sensitive troponin protocol as a default strategy. Conventional ergometry is still the commonly performed stress test with a utilization rate of 47%. Among NSTEMI patients, coronary angiography is planned within 24 h in 96% of all CPUs, irrespective of the day of the week. Prasugrel is the P2Y12 inhibitor of choice in ST-segment elevation myocardial infarction (STEMI), but despite the impact of the ISAR-REACT 5 trial on selection of antiplatelet therapy, ticagrelor is still favored over prasugrel in NSTE-ACS. If triple therapy is used in NSTE-ACS with atrial fibrillation, it is maintained up to 4 weeks in 51% of these patients. Conclusion This survey provides evidence that Germany’s certified CPUs ensure a high level of guideline adherence and quality of care. The survey also identified areas in need of improvement such as the high utilization rate of stress electrocardiogram (ECG).

scholarly journals Effect of PCSK9 E670G and R46L Polymorphisms on Major Adverse Cardio-Cerebrovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Anwar Santoso ◽  
Yulianto Yulianto ◽  
Hendra Simarmata ◽  
Abhirama Nofandra Putra ◽  
Erlin Listiyaningsih
Keyword(s):  
Myocardial Infarction ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Cerebrovascular Events ◽  
St Segment ◽  
Significant Difference

AbstractMajor adverse cardio-cerebrovascular events (MACCE) in ST-segment elevation myocardial infarction (STEMI) are still high, although there have been advances in pharmacology and interventional procedures. Proprotein convertase subtilisin/Kexin type 9 (PCSK9) is a serine protease regulating lipid metabolism associated with inflammation in acute coronary syndrome. The MACCE is possibly related to polymorphisms in PCSK9. A prospective cohort observational study was designed to confirm the association between polymorphism of E670G and R46L in the PCSK9 gene with MACCE in STEMI. The Cox proportional hazards model and Spearman correlation were utilized in the study. The Genotyping of PCSK9 and ELISA was assayed.Sixty-five of 423 STEMI patients experienced MACCE in 6 months. The E670G polymorphism in PCSK9 was associated with MACCE (hazard ratio = 45.40; 95% confidence interval: 5.30–390.30; p = 0.00). There was a significant difference of PCSK9 plasma levels in patients with previous statin consumption (310 [220–1,220] pg/mL) versus those free of any statins (280 [190–1,520] pg/mL) (p = 0.001).E670G polymorphism of PCSK9 was associated with MACCE in STEMI within a 6-month follow-up. The plasma PCSK9 level was higher in statin users.

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

Outcomes of nonagenarians with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Echarte Morales ◽  
P.L Cepas Guillen ◽  
G Caldentey ◽  
E Martinez Gomez ◽  
J Borrego-Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk Population ◽  
High Morbidity ◽  
Baseline Characteristic ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
All Cause Mortality

Abstract Background Myocardial infarction (MI) in nonagenarians is associated with high morbidity and mortality. Nonetheless, this population has typically been underrepresented in cardiovascular clinical trials. Objective The aim of this study was to evaluate outcomes of nonagenarian patients presenting with MI who underwent either conservative or invasive management. Methods We retrospectively included all consecutive patients equal to or older than 90yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristic and procedural data. In-hospital and at 1-year follow-up all-cause mortality and major adverse cardiovascular events were assessed. Results 523 patients (mean age 92.6±2 years; 60% females) were analyzed. Overall, 184 patients (35.2%) underwent percutaneous coronary intervention (PCI), increasing over the years, mostly in STEMI group (from 16% of patients in 2005 to 75% in 2018). PCI was preferred in those subjects with less prevalence of disability for activities of daily living (p<0.01). The use of a radial access (76.6%) and bare metal stents (52.7%) was predominant. No significant differences were found in the incidence of major bleeding events or MI-related mechanical complications between both strategies. During index hospitalization, 99 (18.9%) patients died. Whereas no differences were found in the NSTEMI group (p=0.61), a significant lower in-hospital mortality was observed in STEMI group treated with PCI (p<0.01). At one-year follow up, 203 (38.8%) patients died, most of them due to a cardiovascular cause (60.6%). PCI was related to a lower all-cause mortality in either NSTEMI (p<0.01) or STEMI groups (p<0.01) however, lower cardiovascular mortality was only found in STEMI group (p=0.03). Conclusion An invasive approach was performed in over a third of nonagenarian patients, carrying prognostic implications and with a few numbers of complications. PCI seems to be the preferred strategy for STEMI in this high-risk population in spite of age. Figure 1 Funding Acknowledgement Type of funding source: None

Evolution of hospital discharge medication and 6 months outcomes of ST-Segment Elevation Myocardial Infarction patients in Portugal over the years

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P De Sousa Bispo ◽  
T.F Mota ◽  
R Fernandes ◽  
P Azevedo ◽  
D Carvalho ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Discharge ◽  
Public Institution ◽  
Categorical Variables ◽  
Funding Source ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Discharge Medication ◽  
St Segment

Abstract Objectives To assess the evolution of hospital discharge management, 6 months hospitalization and mortality over the years of all patients admitted with ST segment elevation myocardial infarction (STEMI) in Portugal. Methods A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of Acute Coronary Syndrome since 2002 until 2018 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical status, revascularization strategy, discharge medication and 6 months hospitalization and mortality were obtained. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess trends in categorical variables, and Kruskal-Wallis tests were used to assess trends in numerical variables. A p-value <0.05 was considered statistically significant. Results During the study, a total of 23807 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years. We report a progressive and significant increase the use of primary angioplasty versus fibrinolysis (24.3% to 98.4%, p<0.001), in coronary angioplasties (36.4% to 73.2%, p<0.001), in the use of drug-eluting stents (0% to 70.1%, p<0.001), and a decrease in the patients that underwent surgery (6.8% to 1.3%, p<0.001) and intra-aortic balloon pump (1.8% to 0%, p=0.009), resulting in a decrease in in-hospital mortality from 9.9% to 6.1% (p<0.001). At discharge, we report a progressive increase in the prescription of P2Y12 inhibitors (21.1% to 95.2%, p<0.001), beta-blockers (68.8% to 83.8%, p<0.001), RAAS inhibitors (69.5% to 86.7%, p<0.001) and statins (79.6% to 94.9%, p<0.001), while the prescription of aspirin (94.1% para 94.8%, p=0.428), calcium channel blockers (5.3% to 5.6%, p<0.684) stayed stable, and there was a decrease in the prescription of nitrates (52.9% to 5.8%, p<0.001). Hospital admissions at 6 months consistently and progressively reduced over time (18.6% to 8.5%, p<0.001) as well as mortality (6.7% para 4.3%, p<0.001). Conclusion Post discharge treatment of STEMI patients in Portuguese hospitals has evolved according to guidelines, with higher prescription of medication proven to reduce outcomes, resulting in lower hospitalization rates and mortality. 6 Month Outcomes over the years Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Sociedade Portuguesa de Cardiologia

scholarly journals What the Cardiologist Needs to Consider in the Management of Oncologic Patients with STEMI-Like Syndrome; A Case Report and Literature Review

2021 ◽  
Vol 14 (6) ◽  
pp. 563
Author(s):  
Aneta Aleksova ◽  
Giulia Gagno ◽  
Alessandro Pierri ◽  
Carla Todaro ◽  
Alessandra Lucia Fluca ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Side Effects ◽  
Single Agent ◽  
St Segment Elevation ◽  
Cardiac Catheterization Laboratory ◽  
Cardiac Side Effects ◽  
Coronary Syndrome ◽  
St Segment ◽  
Oncologic Patients

In pre-hospital care, an accurate and quick diagnosis of ST-segment elevation myocardial infarction (STEMI) is imperative to promptly kick-off the STEMI network with a direct transfer to the cardiac catheterization laboratory (cath lab) in order to reduce myocardial infarction size and mortality. Aa atherosclerotic plaque rupture is the main mechanism responsible for STEMI. However, in a small percentage of patients, emergency coronarography does not reveal any significant coronary stenosis. The fluoropyrimidine agents such as 5-Fluorouracil (5-FU) and capecitabine, widely used to treat gastrointestinal, breast, head and neck cancers, either as a single agent or in combination with other chemotherapies, can cause potentially lethal cardiac side effects. Here, we present the case of a patient with 5-FU cardiotoxicity resulting in an acute coronary syndrome (ACS) with recurrent episodes of chest pain and ST-segment elevation.. Our case report highlights the importance of widening the knowledge among cardiologists of the side effects of chemotherapeutic drugs, especially considering the rising number of cancer patients around the world and that fluoropyrimidines are the main treatment for many types of cancer, both in adjuvant and advanced settings.

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