Abstract
Aim. To develop a new methodological approach to assessment of collagen-induced platelet aggregation in patients with coronary artery disease (CAD) and to determine the quality of various methods for detecting high residual platelet reactivity (HRPR) to predict the risk of myocardial perfusion disturbance. Materials and methods. 36 patients (10 men and 26 women) aged 41–83 years and having stable CAD were examined. All patients had been undergoing continuous antiaggregation therapy for 6 months. We evaluated platelet aggregation using a laser analyzer with collagen as an aggregation inducer by the standard method 1 and our own patented method 2. The degree of platelet aggregation (%) and the size of aggregates in relative units (r.u.) in platelet-rich plasma were estimated. Myocardial perfusion scintigraphy with 99mTc-methoxy-isobutylisonitrile was performed according to a two-day stress-rest protocol. The summed stress score (SSS) values were used for analysis. SSS < 4 was regarded as normal myocardial perfusion. Results . The degree of platelet aggregation according to method 1 was 12 (5; 64)%, the aggregate size was 3 (2; 7) r.u. The degree of platelet aggregation according to method 2 was 44 (13; 78)%, and the aggregate size was 5 (4; 8) r.u. Method 2 allowed to diagnose the presence of myocardial ischemia with an aggregation degree ≥ 44.9% with sensitivity of 84% and specificity of 92% (area under the curve (AUC) = 0.89; p < 0.0001; odds ratio (OR) 2.18; 95% confidence interval (CI) 0.57–0.98) and an increase in aggregate size ≥ 4.80 r.u. with sensitivity of 84% and specificity of 84% (AUC = 0.95; p < 0.00001; OR 5.83; 95% CI 0.72–0.99). Conclusion. In patients with CAD, detection of high rates of collagen- induced platelet aggregation using the patented technique is associated with the risk of impaired myocardial perfusion. The developed new methodological approach to detection of HRPR allowed to determine high risk of atherothrombotic complications in additional 22% of the examined patients.
Highlights
We evaluated platelet aggregation using a laser analyzer with collagen as an aggregation inducer by the standard method 1 and our own patented method 2
The degree of platelet aggregation according to method 1 was 12 (5; 64)%, the aggregate size was 3 (2; 7) r.u
The degree of platelet aggregation according to method 2 was 44 (13; 78)%, and the aggregate size was 5 (4; 8) r.u
Summary
Высокая остаточная агрегационная активность тромбоцитов у пациентов с ишемической болезнью сердца: новый методический подход к выявлению. Цель – разработать новый методический подход к оценке коллаген-индуцированной агрегации тромбоцитов у пациентов с ишемической болезнью сердца (ИБС) и определить информативность методик выявления высокой остаточной реактивности тромбоцитов для прогнозирования риска нарушения миокардиальной перфузии. Методика 2 позволила диагностировать наличие нарушений миокардиальной перфузии при степени агрегации ≥44,9% с чувствительностью 84% и специфичностью 92% (AUС = 0,89; р < 0,0001; отношение шансов (ОШ) 2,18; 95%-й доверительный интервал (ДИ) 0,57–0,98) и увеличение размеров агрегатов ≥4,80 отн. У пациентов с ишемической болезнью сердца выявление высоких показателей коллаген-индуцированной агрегации тромбоцитов с помощью запатентованной методики ассоциируется с риском нарушения миокардиальной перфузии. Разработанный новый методический подход по выявлению высокой остаточной реактивности тромбоцитов позволил определить наличие высокого риска развития атеротромботических осложнений дополнительно у 22% обследованных пациентов. Трубачева О.А., Суслова Т.Е., Гусакова А.М. и др
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