EVALUATION OF PLATELET-PLASMA HAEMOSTASIS IN PATIENTS WITH UNSTABLE ANGINA AND STENTING OF THE CORONARY ARTERIES IN THE PRESENCE OF HYPERTENSION

Abstract

Objective: To evaluate the activity of platelet and plasma hemostasis in 143 patients (pts) with unstable angina (UA) and stenting of the coronary arteries against the background of arterial hypertension (AH). Design and method: 143 pts were examine, coronary artery stenting was performed on 3.6 ± 1.2 days after admission. 1 Group 63 (44%) pts without AH, in the 2nd Group 80 (56%) pts with AH initially, at discharge, at 6 and 12 months of observation was performed coagulation, aggregation tests; levels of troponin I, C-reactive protein, myeloperoxidase. Pharmacogenetic testing was carried out by real-time polymerase chain reaction with the BioRad CFX96TM Real-Time PCR Detection Systems. Results: Pts in both Groups were characterized by activation of platelet-plasma haemostasis upon admission, however, in pts with UA with AH (G2) the values were significantly higher: platelet volume (MPV) (9.8fl vs 9.1fl, p = 0.003), FVR (158% vs. 130%, p = 0.041), MPO (348 pmol / L vs. 296 pmol / L, p = 0.001), platelet aggregation level with an AUC (122-U) test against the 106U (TRAP test) p = 0.02) and the AUC of the ADR test (68 U versus 52U, p = 0.02). By the 6th and 12th months of monitoring, significant differences were recorded only between pts G1 and G2, who did not achieve stable target BP values. It should be noted that the pts of both Groups are comparable in polymorphism of the CYP2C19 * 2 gene with the AA and GA variant genotype and the carrier of the A allele, which is associated with high residual platelet reactivity in response to clopidogrel 75 mg and unfavorable outcomes (carriage of the allele in T1-y8 (12.7%) pts, in G2 - in 11 (13.8%) of the pts). During the year of follow-up, repeated cardiovascular complications developed in 31 pts (21.7%), 10 (15.9%) G1, and 21 (26.3%) G2 (p = 0.048) Conclusions: The presence of AH in pts with UA aggravates platelet hyperaggregation and activates plasma and platelet hemostasis,increase in the number of pts with reduced sensitivity to clopidogrel and an increase cardiovascular events.