Reticulated Platelets as Predictor of Myocardial Injury and 30 Day Mortality After Non-cardiac Surgery

Meershoek, Armelle J.A.; Leunissen, Tesse; Waes, Judith A R van; Klei, Wilton A. van; Huisman, Albert; Groot, Mark de; Hoefer, Imo E.; Solinge, Wouter W. van; Moll, Frans L.; Borst, Gert J. de

doi:10.1016/j.ejvs.2019.06.027

Cited by 15 publications

(24 citation statements)

References 48 publications

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“…Combining both hematological parameters with known biological plausibility could explain the clinical utility observed in the multivariate Cox regression model. A high count of reticulated platelets, indicative of higher platelet turnover and production, was independently associated with post-CEA myocardial injury and postoperative mortality [30]. An increased platelet count has been shown to be independently associated with mortality in both ischemic heart disease patients and population-based cohorts [31].…”

Section: Discussionmentioning

confidence: 99%

Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy

Gamas

Jácome

Fragão-Marques

et al. 2020

Cerebrovasc Dis Extra

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Objective: Patients submitted to carotid artery endarterectomy (CEA) have a long-term risk of major adverse cardiovascular events (MACE) of 6–9% at 2 years. Hematological parameters have been shown to have a predictive function in atherosclerotic diseases, namely the red blood cell distribution width-coefficient of variation (RDW-CV). This parameter has been associated with worse outcomes such as myocardial infarction (MI), stroke, and all-cause mortality. This study aims to evaluate the potential role of preoperative hematologic parameters such as RDW-CV in predicting perioperative and long-term cardiovascular adverse events and mortality in patients submitted to CEA. Methods: From January 2012 to January 2019, 180 patients who underwent CEA with regional anesthesia in a tertiary care and referral center were selected from a prospective cohort database. Blood samples were collected preoperatively 2 weeks before admission, including a full blood count. The primary outcome included long-term MACE. Secondary outcomes included all-cause mortality, stroke, MI, acute heart failure, and major adverse limb events (MALE). Results: At baseline, 27.2% of patients had increased RDW-CV. Increased RDW-CV was independently associated with baseline hemoglobin (adjusted odds ratio [aOR] 0.715, 95% CI 0.588–0.869, p = 0.001) and atrial fibrillation (aOR 4.028, 95% CI 1.037–15.639, p = 0.001). After a median follow-up of 50 months, log-rank univariate analysis of RDW-CV demonstrated a significant association between increased RDW-CV and long-term all-cause mortality (log-rank <0.001), MACE (log-rank <0.001), and MI (log-rank = 0.017). After multivariate Cox regression analysis, increased RDW-CV was associated with increased long-term mortality (adjusted hazard ratio [aHR] 2.455, 95% CI 1.231–4.894, p = 0.011) and MACE (aHR 2.047, 95% CI 1.202–3.487, p = 0.008). A decreased hemoglobin to platelet ratio (aHR 2.650e–8, 95% CI 9.049e–15 to 0.078, p = 0.019) was also associated with all-cause mortality. Conclusion: RDW is a widely available and low-cost marker that independently predicts long-term mortality, MACE, and MI after CEA. This biomarker could prove useful in assessing which patients would likely benefit from CEA in the long term.

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Section: Discussionmentioning

confidence: 99%

Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy

Gamas

Jácome

Fragão-Marques

et al. 2020

Cerebrovasc Dis Extra

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“…101 Other investigators found IPF to be a predictor of inflammatory response as well as of myocardial injury and MACE after cardiac or noncardiac surgery. 47,102,103 Altogether, these findings provide evidence of RPs serving as a prognostic biomarker for adverse cardiovascular events in different pathological settings particularly in the cardiovascular field (Table 2).…”

Section: Validation Of Rps As a Prognostic Biomarkermentioning

confidence: 72%

Role of Reticulated Platelets in Cardiovascular Disease

Bongiovanni

Han

Klug

et al. 2022

ATVB

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Human platelets differ considerably with regard to their size, RNA content and thrombogenicity. Reticulated platelets (RPs) are young, hyper-reactive platelets that are newly released from the bone marrow. They are larger and contain more RNA compared to older platelets. In comparison to more mature platelets, they exhibit a significantly higher thrombogenicity and are known to be elevated in patients with an increased platelet turnover such as, diabetics and after acute myocardial infarction. Several studies have shown that RPs correlate with an insufficient antiplatelet response to aspirin and specific P2Y 12 receptor inhibitors. In addition, RPs are promising novel biomarkers for the prediction of adverse cardiovascular events in cardiovascular disease. However, the reason for RPs intrinsic hyper-reactivity and their association with ischemic events is not completely understood and the biology of RPs is still under investigation. We here present a structured review of preclinical and clinical findings concerning the role of RPs in cardiovascular disease.

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“…In patients undergoing major noncardiac surgery, preoperative increased levels of RPs were associated with a higher 30-day mortality and a higher rate of postoperative myocardial injury [59].…”

Section: Immature Platelets and Cardiovascular Diseasementioning

confidence: 93%

Reticulated Platelets in Medicine: Current Evidence and Further Perspectives

Corpataux

Franke

Kille

et al. 2020

JCM

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Reticulated platelets (RPs) are young thrombocytes, newly released from the bone marrow. The identification and quantification of these cells remained difficult for decades due to a lack of standardized preanalytical and analytical methods. With the introduction of automated hematology analyzers in clinical routine, the determination of RPs, either as a total count or as a fraction, became more reliable, faster and more affordable. Currently, RPs are the focus of research in multiple clinical settings. In cardiovascular medicine, recent studies have focused on the relationship between RPs, coronary artery disease (CAD) and clinical outcomes, as well as the impact of RPs on the effects of antiplatelet therapy. Cohort studies showed increased levels of RPs in patients with acute coronary syndrome (ACS) or cardioembolic stroke. In patients with ACS, increased levels of RPs were also associated with an increased incidence of major ischemic cardiovascular events during follow-up. Further studies showed an association of levels of RPs with the antiplatelet response to less-potent P2Y12 inhibitors. In patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation, levels of RPs differed significantly depending on the achieved rhythm (sinus rhythm vs. recurrent atrial fibrillation). Levels of RPs appear to also be predictive for bleeding events in patients with various hematological diagnoses. Although no causal relationship has so far been proven, RP values have been associated with a large number of pathologies and clinical scenarios. This review summarizes the current evidence with regard to RPs and their potential diagnostic and prognostic value for noncardiovascular patients and for cardiovascular patients in particular. It describes further perspectives on how the testing of these cells might improve the treatment of cardiovascular patients.

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Reticulated Platelets as Predictor of Myocardial Injury and 30 Day Mortality After Non-cardiac Surgery

Cited by 15 publications

References 48 publications

Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy

Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy

Role of Reticulated Platelets in Cardiovascular Disease

Reticulated Platelets in Medicine: Current Evidence and Further Perspectives

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