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The Effect of Platelet Functions on Short-term Mortality and Morbidity in ST Elevation Myocardial Infarction
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Original Research
VOLUME: 1 ISSUE: 2
P: 29-36
August 2023

The Effect of Platelet Functions on Short-term Mortality and Morbidity in ST Elevation Myocardial Infarction

Bull Crdiov Acad 2023;1(2):29-36
DOI: 10.4274/kvbulten.galenos.2023.80299
Burcu Yağmur
Kadir Hakan Kültürsay
1. Ege Üniversitesi Tıp Fakültesi Hastanesi, Kardiyoloji Kliniği, İzmir, Türkiye
No information available.
No information available
Received Date: 26.06.2023
Accepted Date: 28.07.2023
Publish Date: 18.09.2023
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ABSTRACT

Objective:

Despite the transfer of the treatment process to pre-hospital settings, shortening of intervention times, and implementation of recommended treatment options, ST-elevation myocardial infarction (STEMI) remains the leading cause of in-hospital death. In our study, the contribution of the reperfusion strategy, clopidogrel loading doses, and adjunctive therapy on platelet aggregation to mortality and morbidity was investigated.

Material and Methods:

Between 2015-2016, 58 patients aged 18-80 years with a diagnosis of STEMI were included in the study. Peripheral venous blood samples were collected at 2nd, 4th, and 24th hours after anti-platelet therapy to evaluate platelet functions. Patients were divided into two groups based on residual platelet aggregation levels in the 4th-hour blood samples: those with aggregation level ≥47U were designated as group A, and those with <47U were designated as group B.

Results:

Our study revealed that patients with high residual platelet aggregation at the 4th hour (group A) received fibrinolytic therapy, underwent a 300 mg clopidogrel loading dose, and used morphine due to persistent pain (p=0.003, p=0.036, p<0.001). It was found that inhospital events increased 6.637-fold in those who received fibrinolysis compared to those who did not [odds ratio (95% confidence interval): 6,637 (1,391-31,658), p=0.018]. When examining the effectiveness of morphine alone on platelet aggregation, it was observed that it was significantly associated with high residual platelet aggregation at 2nd and 4th hours, while this effect decreased at 24th hour (p<0.001, p=0.070). No significant difference was observed in clinical outcomes related to high platelet reactivity.

Conclusion:

Based on the findings, the inadequacy of medical reperfusion strategy and delayed effect of clopidogrel with morphine use were detected. Although this delay did not have clinical significance, it led to a significant increase in hospital admissions with chest pain and the need for repeat revascularization during three-month follow-up. Long-term follow-up results are required.

Keywords:
Myocardial infarction, platelet functions, morphine, prognosis

References

1
Schaar JA, Muller JE, Falk E, Virmani R, Fuster V, Serruys PW, et al. Terminology for high-risk and vulnerable coronary artery plaques. Report of a meeting on the vulnerable plaque, June 17 and 18, 2003, Santorini, Greece. Eur Heart J 2004;25(12):1077-1082.
2
Kainth A, Hewitt A, Sowden A, Duffy S, Pattenden J, Lewin R, et al. Systematic review of interventions to reduce delay in patients with suspected heart attack. Emerg Med J 2004;21(4):506-508.
3
Sima AV, Stancu CS, Simionescu M. Vascular endothelium in atherosclerosis. Cell Tissue Res 2009;335(1):191-203.
4
Libby P. Inflammatory mechanisms: the molecular basis of inflammation and disease. Nutr Rev 2007;65(12 Pt 2):S140-S146.
5
Matetzky S, Shenkman B, Guetta V, Shechter M, Beinart R, Goldenberg I, et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation 2004;109(25):3171-3175.
6
Hochholzer W, Trenk D, Bestehorn HP, Fischer B, Valina CM, Ferenc M, et al. Impact of the degree of peri-interventional platelet inhibition after loading with clopidogrel on early clinical outcome of elective coronary stent placement. J Am Coll Cardiol 2006;48(9):1742-1750.
7
Mehta SR, Tanguay JF, Eikelboom JW, Jolly SS, Joyner CD, Granger CB, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet 2010;376(9748):1233-1243.
8
Michelson AD. Methods for the measurement of platelet function. Am J Cardiol 2009;103(3 Suppl):20A-26A.
9
Tóth O, Calatzis A, Penz S, Losonczy H, Siess W. Multiple electrode aggregometry: a new device to measure platelet aggregation in whole blood. Thromb Haemost 2006;96(6):781-788.
10
Sibbing D, Steinhubl SR, Schulz S, Schömig A, Kastrati A. Platelet aggregation and its association with stent thrombosis and bleeding in clopidogrel-treated patients: initial evidence of a therapeutic window. J Am Coll Cardiol 2010;56(4):317-318.
11
Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RJ, Van de Werf F, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA 2004;291(22):2727-2733.
12
Wong CK, White HD. Value of community-derived risk models for stratifying patients with non-ST elevation acute coronary syndromes. Eur Heart J 2005;26(9):851-852.
13
Tokgözoğlu L, Kaya EB, Erol C, Ergene O; EUROASPIRE III Turkey Study Group. EUROASPIRE III: Türkiye ile Avrupa’nin karşilaştirilmasi. Turk Kardiyol Dern Ars 2010;38(3):164-172.
14
Xanthopoulou I, Davlouros P, Tsigkas G, Koutsogiannis N, Patsilinakos S, Deftereos S, et al. Factors Affecting Platelet Reactivity 2 Hours After P2Y₁₂ Receptor Antagonist Loading in Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction - Impact of Pain-to-Loading Time. Circ J 2016;80(2):442-449.
15
Sibbing D, Braun S, Morath T, Mehilli J, Vogt W, Schömig A, et al. Platelet reactivity after clopidogrel treatment assessed with point-of-care analysis and early drug-eluting stent thrombosis. J Am Coll Cardiol 2009;53(10):849-856.
16
Rubak P, Villadsen K, Hvas AM. Reference intervals for platelet aggregation assessed by multiple electrode platelet aggregometry. Thromb Res 2012;130(3):420-423.
17
Hobl EL, Stimpfl T, Ebner J, Schoergenhofer C, Derhaschnig U, Sunder-Plassmann R, et al. Morphine decreases clopidogrel concentrations and effects: a randomized, double-blind, placebo-controlled trial. J Am Coll Cardiol 2014;63(7):630-635.
18
Parodi G, Valenti R, Bellandi B, Migliorini A, Marcucci R, Comito V, et al. Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients: RAPID (Rapid Activity of Platelet Inhibitor Drugs) primary PCI study. J Am Coll Cardiol 2013;61(15):1601-1606.
19
Hobl EL, Reiter B, Schoergenhofer C, Schwameis M, Derhaschnig U, Lang IM, et al. Morphine interaction with prasugrel: a double-blind, cross-over trial in healthy volunteers. Clin Res Cardiol 2016;105(4):349-355.
20
Bonin M, Mewton N, Roubille F, Morel O, Cayla G, Angoulvant D, et al. Effect and Safety of Morphine Use in Acute Anterior ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2018;7(4):e006833.