Platelet reactivity expressed as a novel platelet reactivity score is associated with higher inflammatory state after coronary artery bypass grafting

Abstract

Introduction: Despite therapy, patients operated using a cardiopulmonary bypass demonstrate increased platelet aggregation, which rebounds to above preoperative levels. The aim of the study was to test the interaction between platelet reactivity/activation and selected inflammatory markers in the post-operative period. Material and methods: In total, 103 patients with non-ST elevation acute coronary syndrome (NSTE-ACS) who were not eligible for percutaneous coronary interventions (PCI), and required urgent revascularization, were included. Platelet reactivity was measured using the PFA-100 platelet analyser, multiple electrode aggregometry, and was expressed as a novel platelet reactivity score (PRS). Patients were divided using their PRS scores into high platelet relativity or low platelet reactivity subgroups (HPR or LPR). Platelet basal activation was measured using immunoassays for soluble P-selectin and soluble CD40L. We measured high-sensitivity C-reactive protein (CRP), and used immunoassays for tumour necrosis factor α (TNF-α) and interleukin 6 (IL-6) as inflammation markers. Results: Significant differences between HPR and LPR groups were found for CRP (mg/l): 81.5 vs. 44.6, p < 0.02; and TNF-α (pg/l): 3.51 vs. 2.37, p < 0.02. A significant association was found between CRP, TNF-α, IL-6 and platelet reactivity (platelet reactivity score). Cohen's k showed: CRP = 0.49, p < 0.0001, TNF-α = 0.37, p < 0.002. Perioperative myocardial infarction and rhythm disturbances occurred more frequently in the high platelet reactivity group: 7 (16.3%) vs. 2 (3.3%), p < 0.04, and 9 (20.9%) vs. 4 (6.7%), p < 0.04, respectively. Conclusions: Inflammatory parameters CRP and TNF-α are strongly associated with platelet reactivity (expressed as PRS) in cardiopulmonary bypass graft patients. Platelet hyperreactivity in the early post-operative period combined with a systemic inflammatory state correlates with a higher risk of post-operative rhythm disturbances and myocardial infarction.

Platelet Reactivity in the Exacerbation of Psoriasis

“…The absolute difference in MPA between these groups was only 2%, but it reached statistical significance (75% vs. 73%; p = 0.02). We found this result surprising, as we rather anticipated the opposite, as obesity causes the chronic low-grade inflammation of adipose tissue [38], and interactions between inflammation and elevated platelet aggregation have been previously described [21][22][23][24][25][26]. Indeed, our finding is inconsistent with other reports.…”

“…Moreover, excessive platelet reactivity is a predictor of cardiovascular and all-cause mortality, and a risk equivalent to the presence of coronary artery disease in patients not receiving antiaggregatory therapy as well [21]. Finally, elevated concentrations of inflammatory markers, such as C-reactive protein (CRP), tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), or IL-10, correlate to higher platelet reactivity [21][22][23][24][25][26].…”

An Evaluation of Plasma TNF, VEGF-A, and IL-6 Determination as a Risk Marker of Atherosclerotic Vascular Damage in Early-Onset CAD Patients

“…Other authors have reported different TNF plasma concentrations. The range is from a few [ 33 ] to several tens of pg/mL [ 34 ] in CAD patients, while in healthy people, it is about 2 pg/mL [ 35 ]. Our patients were all treated with statins, which reduce plasma TNF levels [ 36 ].…”

Could Tumor Necrosis Factor Serve as a Marker for Cardiovascular Risk Factors and Left Ventricular Hypertrophy in Patients with Early-Onset Coronary Artery Disease?

“…Different authors report different levels of plasma TNF concentrations. The range varies from a few [39] to several tens of pg/mL [40] in people with CAD and approximately 2 pg/mL in healthy people [41]. Statins reduce plasma TNF levels [42], and our patients were all treated with statins.…”