Platelet counts on admission affect coronary flow,myocardial perfusion and left ventricular systolic function after primary percutaneous coronary intervention

Abstract

Background:

Patients with acute ST-elevation myocardial infarction (STEMI) and increased platelet count treated by fibrinolysis have worse outcomes.

Aim:

The aim of this study was to test the hypothesis that platelet blood count at admission in patients with acute STEMI treated by primary percutaneous coronary intervention affects coronary flow, myocardial perfusion and recovery of left ventricular systolic function.

Methods:

A total of 174 patients presenting with acute anterior STEMI and treated with primary percutaneous coronary intervention were included and divided into subgroups of admission platelet blood count of <200 K, 200–300 K, 300–400 K and >400 K. Evaluation of coronary artery flow and myocardial blush grade was performed according to the TIMI criteria. Electrocardiographic ST elevation resolution post-primary percutaneous coronary intervention was evaluated. Doppler echocardiographic evaluation of left anterior descending coronary artery velocities early and late after primary percutaneous coronary intervention and assessment of left ventricular ejection fraction and wall motion score index (WMSI) of left ventricular and left anterior descending coronary artery territory were performed.

Results:

Post-primary percutaneous coronary intervention TIMI, myocardial blush grade and ST elevation resolution were similar in all groups. Patients with platelet counts <200 K had higher peak diastolic left anterior descending coronary artery velocity both early and late after primary percutaneous coronary intervention, and higher prevalence of left anterior descending coronary artery velocity deceleration time exceeding 600 ms, (45.5% vs. 40%, P<0.05). Patients with platelet counts >400 K presented with worse left ventricular ejection fraction, left ventricular WMSI and left anterior descending coronary artery WMSI, and before discharge this subgroup had worse left ventricular WMSI and left anterior descending coronary artery WMSI, P<0.01.

Conclusions:

Patients with anterior STEMI treated by primary percutaneous coronary intervention with lower admission platelet count had higher left anterior descending coronary artery diastolic velocities, better myocardial perfusion with more patients having left anterior descending coronary artery–descending coronary artery velocity deceleration time >600 ms. Patients with higher platelet counts had lower left ventricular systolic function both at admission and before discharge.

Keywords

Acute anterior STEMI primary coronary angioplasty platelet count left ventricular systolic function Doppler echocardiography coronary artery flow

Get full access to this article

View all access options for this article.

References

Hansson

. Inflammation, atherosclerosis and coronary artery disease. N Engl J Med 2005; 352: 1685–1659.

Yusuf

Vaz

Pais

. Tackling the challenge of cardiovascular disease burden in developing countries. Am Heart J 2004; 1: 1481.

American Heart Association. Heart disease and stroke statistics – 2007 update. Circulation 2007; 69: 115.

Davies

Thomas

. Thromobosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med 1984; 310: 1137–1140.

Falk

Shah

Fuster

. Coronary plaque disruption. Circulation 1995; 92: 657–671.

Davies

. Stability and instability: two faces of coronary atherosclerosis. Circulation 1996; 94: 2013–2020.

Furie

. Mechanisms of thrombus formation. N Engl J Med 2008; 359: 938.

Ware

Coller

. Platelet morphology, biochemistry and function. In Williams’ Hematology, New York: McGraw-Hill, 1994; pp. 1161.

Lauri

Cerletti

de Geatano

. Amplification of primary response of human platelets to platelet-activating factor: aspirin-sensitive and aspirin-insensitive pathways. J Lab Clin Med 1985; 105: 653.

10.

De Wood

Spores

Notske

. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 1980; 303: 897.

11.

Falk

. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation 1985; 71: 699.

12.

Kirtane

Murphy

.; TIMI Study Group. Association of platelet counts on presentation and clinical outcomes in ST-elevation myocardial infarction (from the TIMI Trials). Am J Cardiol 2006; 98: 1–5.

13.

Paul

Sen

Bari

. Correlation of platelet count and acute ST-elevation in myocardial infarction. Mymensingh Med J 2010; 19(3): 469–473.

14.

Grines

Brown

Marco

. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction: the Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 1993; 328: 673–679.

15.

Zijlstra

de Boer

Hoorntje

. A comparison of immediate angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med 1993; 38: 680–684.

16.

GUSTO IIb Investigators. A clinical trial comparing primary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med 1997; 336: 1621–1628.

17.

De Luca

van ’t Hof

de Boer

. Time to treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty. Eur Heart J 2004; 25: 1009–1013.

18.

Wiviott

Braunwald

McCabe

. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 357(20): 2001–2015.

19.

Stone

Witzenbichler

Guagliumi

. Bivalirudin during Primary PCI in Acute Myocardial Infarction the HORIZONS–AMI Trial. N Engl J Med 2008; 358: 2218–2230.

20.

Gibson

de Lemos

Murphy

. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation 2001; 103: 2550–2554.

21.

Kaplan

Kiris

. Impact of initial platelet count on baseline angiographic finding and end-points in ST-elevation myocardial infarction referred for primary percutaneous coronary intervention. Int J Clin Exp Med 2014; 7(4): 1064–1070.

22.

Yunoki

Naruko

Sugioka

. Erythrocyte-rich thrombus aspirated from patients with ST-elevation myocardial infarction: association with oxidative stress and its impact on myocardial reperfusion. Eur Heart J 2012; 33: 1480–1490.

23.

Turakhia

Murphy

Pinto

.; Thrombolysis in Myocardial Infarction Study Group. Association of platelet count with residual thrombus in the myocardial infarct-related coronary artery among patients treated with fibrinolytic therapy for ST-segment elevation acute myocardial infarction. Am J Cardiol 2004; 94: 1406–1410.

24.

Wong

French

Gao

. Relation of initial platelet counts to thrombolysis in myocardial infarction-3 flow rates at 90 minutes after commencing fibrinolytic therapy in patients with acute myocardial infarction. Am J Cardiol 2002; 90: 54–57.

25.

Mueller

Neumann

Hochholzer

. The impact of platelet count on mortality in unstable angina/non-ST-segment elevation myocardial infarction. Am Heart J 2006; 151: 1214, e1–7.

26.

Nikolsky

Grines

Cox

. Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). Am J Cardiol 2007; 99: 1055–1061.