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The impact of platelet function or C-reactive protein, on cardiovascular events after an acute myocardial infarction
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
2009 (Engelska)Ingår i: Thrombosis Journal, ISSN 1477-9560, E-ISSN 1477-9560, Vol. 7, nr 12Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background Recurrent cardiovascular events following acute myocardial infarction (AMI) are common. The purpose of this study was to evaluate the impact of platelet aggregation, PFA-100 closure times and peak C-reactive protein (CRP), respectively, on the occurrence of death, myocardial infarction and ischemic cerebral events after an AMI. Furthermore, to examine the relationship between the platelet function tests and peak CRP.

Methods Three hundred and thirty-four patients with AMI were included in the study. Platelet aggregation was analyzed by an aggregometer using laser light (PA-200). The state of high residual platelet reactivity was defined as normal closure times (PFA-100) during treatment with antiplatelet and antithrombotic drugs.

Results The fourth quartile of peak CRP was associated with poorer outcome as compared to the first quartile in a multivariate Cox-regression analysis, with a hazard ratio of 2.0 (95% CI 1.1-3.7) for the occurrence of death, myocardial infarction and ischemic cerebral events. The fourth quartile of peak CRP (>64.6 mg/l) was associated with platelet aggregation (p < 0.001, adjusted R² = 0.13) and high residual platelet reactivity, in a multivariable model, with an odds ratio of 2.9 (CI 95% 1.3-6.8), as compared to the first quartile. Neither the highest quartile of platelet aggregation nor the state of high residual platelet reactivity predicted new cardiovascular events.

Conclusions In patients with myocardial infarction, measured peak CRP is associated with new cardiovascular events. Despite an association with peak CRP neither more pronounced platelet aggregation nor PFA-100 closure times independently predict new cardiovascular events.

Ort, förlag, år, upplaga, sidor
BioMed Central , 2009. Vol. 7, nr 12
Nyckelord [en]
C-reactive protein, Myocardial infarction, Platelets, Aggregation, PFA-100, Outcome
Nationell ämneskategori
Kardiologi
Forskningsämne
medicin
Identifikatorer
URN: urn:nbn:se:umu:diva-31869DOI: 10.1186/1477-9560-7-12PubMedID: 19583836OAI: oai:DiVA.org:umu-31869DiVA, id: diva2:297965
Projekt
Inflammation, platelet aggregation and prognosis after acute myocardial infarctionTillgänglig från: 2010-03-08 Skapad: 2010-02-19 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. Inflammation, platelet aggregation and prognosis in acute myocardial infarction
Öppna denna publikation i ny flik eller fönster >>Inflammation, platelet aggregation and prognosis in acute myocardial infarction
2010 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The incidence of stroke and re-infarction is noticeably high in the first few days following acute myocardial infarction. This finding has raised questions whether the systemic inflammatory reaction secondary to myocardial necrosis is involved. The inflammation might affect the activation of platelets leading to insufficient effect of the antiplatelet treatment given. Furthermore, the importance of platelet reactivity and inflammation in terms of long-term prognosis is not fully understood. The prognostic importance of C-reactive protein (CRP) in relation to clinical variables also needs to be clarified.

The present studies are aimed at describing the dynamics of platelet function during the first days of an acute myocardial infarction, in relation to diabetes and inflammation. We also investigated whether increased platelet reactivity or the increased concentration of CRP in blood were related to a worse outcome. Finally, we examined if CRP levels contributed to a predictive model using clinical variables known to affect outcome in patients with AMI.

 We used two novel platelet function tests to measure platelet reactivity; the PA-200 (a laser light aggregometer) and the PFA-100 (measures primary haemostasis in whole blood).

Platelet aggregation increased during the initial course of an acute myocardial infarction. The increase in platelet aggregation was most pronounced in diabetics and in patients showing higher systemic inflammatory reaction, assessed by measuring the concentration of CRP in blood. The pronounced platelet aggregation occurred despite ongoing antiplatelet and antithrombotic treatment.

There was a significant association between the levels of CRP and the degree of platelet reactivity. However, while the CRP levels were associated with a worse outcome (AMI, stroke and death), the results of the platelet function tests were not. The importance of CRP in predicting prognosis depended on which adjustments were made for confounding factors.

CRP and prognostic variables in a statistical model predicting death, however, showed that CRP was excluded. Thus CRP did not predict outcome beyond clinical prognostic variables.

The results of these studies reinforce the importance of clinical variables such as heart failure, age, atrial fibrillation, smoking status, diabetes and impaired kidney function - all of which were associated with worse prognosis in multivariable analysis.

Förlag
s. 49
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1343
Nyckelord
Myocardial infarction, C-reactive protein, platelet aggregation, prognosis
Nationell ämneskategori
Kardiologi
Forskningsämne
medicin
Identifikatorer
urn:nbn:se:umu:diva-32519 (URN)978-91-7264-845-6 (ISBN)
Disputation
2010-04-29, Sal B, 9 trappor, By 1D, Tandläkarhögskolan, Umeå universitets sjukhus, Umeå, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2010-03-19 Skapad: 2010-03-16 Senast uppdaterad: 2010-03-19Bibliografiskt granskad

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