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Association of level of kidney function and platelet aggregation in acute myocardial infarction
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
2009 (English)In: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 54, no 2, 262-269 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Decreased kidney function has been established as an important risk factor in patients presenting with acute coronary syndrome. In acute coronary syndrome, increased platelet aggregation is associated with vascular complications. The aim of this study is to examine whether decreased kidney function is associated with altered platelet function in patients presenting with acute myocardial infarction. STUDY DESIGN: Prospective cohort.

SETTING & PARTICIPANTS: 413 patients presenting with acute myocardial infarction admitted to the cardiac intensive care unit at Ostersund Hospital, Ostersund, Sweden.

PREDICTORS: Glomerular filtration rate less than 60 mL/min/1.73 m(2) estimated from serum cystatin C level, comorbidity, medications, and markers of inflammation and hemostasis.

OUTCOMES & MEASUREMENTS: Platelet aggregation was assessed by measuring the formation of small platelet aggregates (SPAs) by using a laser light scattering method. A greater SPA level indicates greater platelet aggregation. Platelet aggregation analysis was performed on days 1, 2, 3, and 5 in-hospital. RESULTS: We observed a significant increase in platelet aggregation during the first 3 days in the hospital regardless of kidney function (P < 0.001). Platelet aggregation was more pronounced in patients with estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) on day 2 (SPA count, 65,000 versus 47,000; P = 0.01) and day 3 (SPA count, 77,000 versus 52,000; P = 0.02). In a multiple linear regression analysis, decreased kidney function was no longer significantly associated with increased platelet aggregation. Older age, greater plasma fibrinogen level, and diabetes mellitus were associated with increased platelet aggregation in the multivariable model.

LIMITATIONS: During the study period, 78 patients presenting with acute myocardial infarction were not eligible for inclusion. Differences in treatment with antiplatelet medication between the 2 groups might have affected our findings.

CONCLUSIONS: Platelet aggregation increases during the first days after acute myocardial infarction regardless of kidney function. There is no difference in platelet aggregation in patients according to level of kidney function.

Place, publisher, year, edition, pages
2009. Vol. 54, no 2, 262-269 p.
Keyword [en]
Platelet aggregation; myocardial infarction; chronic kidney disease
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-32936DOI: 10.1053/j.ajkd.2009.04.023PubMedID: 19560852OAI: oai:DiVA.org:umu-32936DiVA: diva2:306778
Available from: 2010-03-31 Created: 2010-03-31 Last updated: 2012-01-27Bibliographically approved
In thesis
1. Platelet reactivity and comorbidities in acute coronary syndrome
Open this publication in new window or tab >>Platelet reactivity and comorbidities in acute coronary syndrome
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Trombocytreaktivitet och komorbiditet vid akut koronart syndrom
Abstract [en]

Background In the event of an acute coronary syndrome (ACS), the risk of death and complications such as stroke and re-infarction is high during the first month. Diabetes, impaired kidney function, elevated markers of systemic inflammation and high level of platelet reactivity have all been associated with worsened prognosis in ACS patients. Impaired kidney function is a condition with high cardiovascular morbidity and there is an established association between level of kidney function and outcome in the event of an ACS.

Aims We sought to investigate the level of platelet reactivity during the first days of an ACS and specifically the level of platelet reactivity in patients with different conditions associated with worsened prognosis in the event of an ACS. We also wanted to investigate the prognostic impact of baseline levels of cystatin C as well as the importance of decreasing kidney function during the first days of an ACS.

Methods We included 1028 unselected patients with ACS or suspected ACS during the years 2002 and 2003, of which 534 were diagnosed with an acute myocardial infarction (AMI). Blood samples for measuring platelet aggregation, cystatin C levels and other clinically important biomarkers were collected day 1, 2, 3 and 5 following admission.

Platelet reactivity was measured using 2 different methods. Platelet aggregation was measured using Pa-200, a particle count method, based on scattering of laser light. PFA 100 is a method of measuring primary hemostasis in whole blood.

Results

Platelet aggregation and comorbidities.

We found an increase in platelet aggregation when an ACS was complicated by an infection and there was an increased frequency of aspirin non-responsiveness in patients suffering from pneumonia during the first days of an ACS. Furthermore, we found an independent association between levels of C-reactive protein and platelet aggregation.

During the first 3 days following an acute myocardial infarction, platelet aggregation increased despite treatment with anti-platelet agents.

Platelet aggregation was found to be more pronounced in patients with diabetes.

Patients with impaired kidney function, showed increased platelet aggregation compared to patients with normal renal function, however, this difference was explained by older age, higher prevalence of DM and levels of inflammatory biomarkers. We found no independent association between chronic kidney disease (CKD) and levels of platelet aggregation.

Kidney function and outcome

Serum levels of cystatin C on admission had an independent association with outcome following an acute myocardial infarction. With a mean follow-up time of 2.9 years, the adjusted HR for death was 1.62 (95% CI 1.28-2.03; p<0.001) for each unit of increase in cystatin C on admission.

The level of dynamic changes in cystatin C during admission for an acute myocardial infarction was independently associated with prognosis in patients with normal or mild impairment of renal function. The adjusted HR for death was 10.1 (95% CI 3.4-29.9; p<0.001).

Conclusion In patients suffering from an AMI platelet aggregation increases during the first days, despite anti-platelet treatment. Diabetes, age and biomarkers of inflammation are independently associated with platelet aggregation.

Admission levels of cystatin C as well as changes in cystatin C levels during hospitalisation are independently associated with outcome.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2012. 53 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1477
Keyword
acute coronary syndrome, myocardial infarction, platelet reactivity, platelet aggregation, Inflammation, infection, diabetes mellitus, chronic kidney disease, acute kidney injury
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-51096 (URN)978-91-7459-361-7 (ISBN)
Public defence
2012-02-17, Hörsalen, Östersunds Sjukhus, Östersund, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-01-27 Created: 2012-01-10 Last updated: 2012-01-27Bibliographically approved

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Karlsson, FredrikModica, AngeloMooe, Thomas

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