Research Article
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Stent Restenozunu Öngörmede Potansiyel Bir Belirteç: Platelet Dağılım Aralığı/Platelet Oranı

Year 2018, Volume: 71 Issue: 2, 123 - 129, 10.10.2018

Firdevs Ayşenur Ekizler

Abstract

Amaç: Plateletlerin in-stent restenoz (İSR) patogenezinde önemli rolleri vardır. Platelet dağılım aralığının platelet sayısına oranı (PDW/platelet) yakın zaman önce ortaya çıkan bir belirteçtir. Bu oranın koroner arter hastalığında stent restenozunu öngörmedeki prediktif değeriyle ilgili veri yoktur. Çalışmamızda bu nedenle kararlı veya kararsız anjina nedeniyle çıplak metal stent takılan hastalarda prosedür öncesi bakılan PDW/platelet oranının İSR’nin öngörmedeki rolünü araştırmayı amaçladık.

Gereç ve Yöntem: Çalışmamızda elektif çıplak metal stent takılan ve anjina ya da iskemi nedeniyle nedeniyle kontrol anjiyografileri yapılan toplam 763 ardışık hastanın [ortalama yaş 60,3±10,2 yıl, 546 (%71) erkek]; klinik, biyokimyasal ve anjiyografik verilerini retrospektif olarak inceledik.

Bulgular: Stent implantasyonu ve kontrol koroner anjiyografi arasındaki zaman periyodu ortalama 15,3±8,7 aydı. Prosedür öncesi bakılan PDW/platelet oranı İSR olan hastalarda anlamlı olarak daha yüksekti (odds ratio, 3,43; %95 güven aralığı, 2,02-5,83; p<0,001). Sigara içme, ürik asit düzeyi, C-reaktif protein seviyeleri ve PDW/platelet oranları İSR’nin bağımsız öngördürücüleri olarak saptandı.

Sonuç: Kararlı ve kararsız anjinası olup çıplak metal stent takılan hastalarda PDW/platelet oranı İSR’nin bağımsız ve güçlü bir prediktörüdür.

Keywords

Belirteç İn-stent Restenoz Platelet Dağılım Aralığının Platelet Sayısına Oranı

Ethical Statement

Etik Kurul Onayı: Çalışma için Sağlık Bilimleri Üniversitesi, Ankara Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi Etik Kurulu’ndan onay alınmıştır (tarih: 09.07.2018, no: 7806).

Project Number

-

References

  • 1. Jukema JW, Ahmed TA, Verschuren JJ, et al. Restenosis after PCI. Part 2: prevention and therapy. Nat Rev Cardiol 2011;9:79-90.
  • 2. Jukema JW, Verschuren JJ, Ahmed TA, et al. Restenosis after PCI. Part 1: pathophysiology and risk factors. Nat Rev Cardiol 2011;9:53-62.
  • 3. Liu MW, Roubin GS, King SB 3rd. Restenosis after coronary angioplasty. Potential biologic determinants and role of intimal hyperplasia. Circulation 1989;79:1374-1387.
  • 4. Welt FG, Rogers C. Inflammation and restenosis in the stent era. Arterioscler Thromb Vasc Biol 2002;22:1769-1776.
  • 5. Gardiner EE, Andrews RK. Structure and function of platelet receptors initiating blood clotting. Adv Exp Med Biol 2014;844:263-275.
  • 6. Gasparyan AY, Ayvazyan L, Mikhailidis DP, et al. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011;17:47-58.
  • 7. Golebiewska EM, Poole A. Platelet secretion: From haemostasis to wound healing and beyond. Blood Rev 2015;29:153-162.
  • 8. Chandrasekar B, Tanguay JF. Platelets and restenosis. J Am Coll Cardiol 2000;35:555-562.
  • 9. Inoue T, Sohma R, Miyazaki T, et al. Comparison of activation process of platelets and neutrophils after coronary stent implantation versus balloon angioplasty for stable angina pectoris. Am J Cardiol 2000;86:1057-1062.
  • 10. Huczek Z, Filipiak KJ, Kochman J, et al. Baseline platelet size is increased in patients with acute coronary syndromes developing early stent thrombosis and predicts future residual platelet reactivity. A case-control study. Thromb Res 2010;125:406-412.
  • 11. Huczek Z, Kochman J, Filipiak KJ, et al. Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol 2005;46:284-290.
  • 12. Norgaz T, Hobikoglu G, Aksu H, et al. The relationship between preprocedural platelet size and subsequent in-stent restenosis. Acta Cardiol 2004;59:391-395.
  • 13. Ranjith MP, Divya R, Mehta VK, et al. Significance of platelet volume indices and platelet count in ischaemic heart disease. J Clin Pathol 2009;62:830-833.
  • 14. Vagdatli E, Gounari E, Lazaridou E, et al. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia 2010;14:28-32.
  • 15. Korovesis S, Fredericks S, Holt D, et al. Release of platelet activation markers during coronary angioplasty. Coron Artery Dis 2000;11:391-398.
  • 16. Purbiya P, Golwala ZM, Manchanda A, et al. Platelet Distribution Width to Platelet Count Ratio as an Index of Severity of Illness. Indian J Pediatr 2018;85:10-14.
  • 17. Golwala ZM, Shah H, Gupta N, et al. Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study. Afr Health Sci 2016;16:356-362.
  • 18. Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drugeluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2007;370:937-948.
  • 19. Inoue T, Croce K, Morooka T, et al. Vascular inflammation and repair: implications for re-endothelialization, restenosis, and stent thrombosis. JACC Cardiovasc Interv 2011;4:1057-1066.
  • 20. Gilbert J, Raboud J, Zinman B. Meta-analysis of the effect of diabetes on restenosis rates among patients receiving coronary angioplasty stenting. Diabetes Care 2004;27:990-994.
  • 21. Hong SJ, Kim MH, Ahn TH, et al. Multiple predictors of coronary restenosis after drug-eluting stent implantation in patients with diabetes. Heart 2006;92:1119-1124.
  • 22. Hu RT, Liu J, Zhou Y, et al. Association of smoking with restenosis and major adverse cardiac events after coronary stenting: A meta-analysis. Pak J Med Sci 2015;31:1002-1008.
  • 23. Singh M, Gersh BJ, McClelland RL, et al. Clinical and angiographic predictors of restenosis after percutaneous coronary intervention: insights from the Prevention of Restenosis With Tranilast and Its Outcomes (PRESTO) trial. Circulation 2004;109:2727-2731.
  • 24. Italiano JE Jr, Shivdasani RA. Megakaryocytes and beyond: the birth of platelets. J Thromb Haemost 2003;1:1174-1182.
  • 25. Ault KA, Rinder HM, Mitchell J, et al. The significance of platelets with increased RNA content (reticulated platelets). A measure of the rate of thrombopoiesis. Am J Clin Pathol 1992;98:637-646.
  • 26. Brown AS, Martin JF. The megakaryocyte platelet system and vascular disease. Eur J Clin Invest 1994;24(Suppl 1):9-15.
  • 27. Martin JF, Trowbridge EA, Salmon G, et al. The biological significance of platelet volume: its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration. Thromb Res 1983;32:443-460.
  • 28. T Thompson CB, Eaton KA, Princiotta SM, et al. Size dependent platelet subpopulations: relationship of platelet volume to ultrastructure, enzymatic activity, and function. Br J Haematol 1982;50:509-519.
  • 29. Grove EL, Hvas AM, Kristensen SD. Immature platelets in patients with acute coronary syndromes. Thromb Haemost 2009;101:151-156.
  • 30. Martin JF, Kristensen SD, Mathur A, et al. The causal role of megakaryocyteplatelet hyperactivity in acute coronary syndromes. Nat Rev Cardiol 2012;9:658-670.
  • 31. Freynhofer MK, Bruno V, Brozovic I, et al. Is increased platelet turnover responsible for low responsiveness to different thienopyridienes? A case report of recurrent stent thromboses. Thromb Haemost 2011;106:182-184.
  • 32. Grove EL, Hvas AM, Mortensen SB, et al. Effect of platelet turnover on whole blood platelet aggregation in patients with coronary artery disease. J Thromb Haemost 2011;9:185-191.
  • 33. Khode V, Sindhur J, Kanbur D, et al. Mean platelet volume and other platelet volume indices in patients with stable coronary artery disease and acute myocardial infarction: A case control study. J Cardiovasc Dis Res 2012;3:272-275.
  • 34. Kern A, Gil RJ, Bojko K, et al. Platelet distribution width as the prognostic marker in coronary bifurcation treatment. Eur J Clin Invest 2017;47:524-530.
  • 35. Ege MR, Guray U, Guray Y, et al. Platelet distribution width and saphenous vein disease in patients after CABG. Association with graft occlusion. Herz 2013;38:197-201.
  • 36. Ritchie JL, Harker LA. Platelet and fibrinogen survival in coronary atherosclerosis. Response to medical and surgical therapy. Am J Cardiol 1977;39:595-598.
  • 37. Khandekar MM, Khurana AS, Deshmukh SD, et al. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol 2006;59:146-149.
  • 38. Ferrante G, Niccoli G, Biasucci LM, et al. Association between C-reactive protein and angiographic restenosis after bare metal stents: an updated and comprehensive meta-analysis of 2747 patients. Cardiovasc Revasc Med 2008;9:156-165.
  • 39. Schoos MM, Kelbæk H, Kofoed KF, et al. Usefulness of preprocedure high-sensitivity C-reactive protein to predict death, recurrent myocardial infarction, and stent thrombosis according to stent type in patients with ST-segment elevation myocardial infarction randomized to bare metal or drug-eluting stenting during primary percutaneous coronary intervention. Am J Cardiol 2011;107:1597-1603.
  • 40. Carlquist JF, Knight S, Horne BD, et al. Cardiovascular risk among patients on clopidogrel anti-platelet therapy after placement of drug-eluting stents is modified by genetic variants in both the CYP2C19 and ABCB1 genes. Thromb Haemost 2013;109:744-754.
  • 41. Mao L, Jian C, Changzhi L, et al. Cytochrome CYP2C19 polymorphism and risk of adverse clinical events in clopidogrel-treated patients: a metaanalysis based on 23,035 subjects. Arch Cardiovasc Dis 2013;106:517-527

A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio

Year 2018, Volume: 71 Issue: 2, 123 - 129, 10.10.2018

Firdevs Ayşenur Ekizler

Abstract

Objectives: Platelets play significant role in the pathogenesis of in-stent restenosis (ISR). Platelet distribution width to platelet count ratio (PDW/platelet) is a new marker. There are no data available regarding the predictive role of PDW/platelet ratio for ISR in patients with coronary artery disease. The present study aimed to search the predictive value of preprocedural PDW/platelet ratio on in-stent restenosis in patients with stable or unstable angina pectoris undergoing coronary bare-metal stent implantation.

Materials and Methods: We retrospectively analyzed clinical, biochemical, and angiographic data from 763 consecutive patients [mean age 60.3±10.2 years, 546 (71%) male]; all patients had undergone elective bare-metal stent implantation and further control coronary angiography owing to angina pectoris or ischemia.

Results: The mean period between stent implantation and control coronary angiography procedures was 15.3±8.7 months. The preprocedural PDW/platelet ratios were significantly higher in patients that had ISR (odds ratio, 3.43; 95% confidence interval, 2.02-5.83; p<0.001). Smoking, uric acid, C-reactive protein levels and PDW/platelet levels identified as independent predictors of ISR.

Conclusion: Our results demonstrate that higher PDW/platelet ratio is an independent and powerful predictor of ISR in patients with stable or unstable angina pectoris who underwent successful bare-metal stent implantation

Keywords

Marker In-stent Restenosis Platelet Distribution Width to Platelet Count Ratio

Supporting Institution

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Project Number

-

Thanks

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References

  • 1. Jukema JW, Ahmed TA, Verschuren JJ, et al. Restenosis after PCI. Part 2: prevention and therapy. Nat Rev Cardiol 2011;9:79-90.
  • 2. Jukema JW, Verschuren JJ, Ahmed TA, et al. Restenosis after PCI. Part 1: pathophysiology and risk factors. Nat Rev Cardiol 2011;9:53-62.
  • 3. Liu MW, Roubin GS, King SB 3rd. Restenosis after coronary angioplasty. Potential biologic determinants and role of intimal hyperplasia. Circulation 1989;79:1374-1387.
  • 4. Welt FG, Rogers C. Inflammation and restenosis in the stent era. Arterioscler Thromb Vasc Biol 2002;22:1769-1776.
  • 5. Gardiner EE, Andrews RK. Structure and function of platelet receptors initiating blood clotting. Adv Exp Med Biol 2014;844:263-275.
  • 6. Gasparyan AY, Ayvazyan L, Mikhailidis DP, et al. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011;17:47-58.
  • 7. Golebiewska EM, Poole A. Platelet secretion: From haemostasis to wound healing and beyond. Blood Rev 2015;29:153-162.
  • 8. Chandrasekar B, Tanguay JF. Platelets and restenosis. J Am Coll Cardiol 2000;35:555-562.
  • 9. Inoue T, Sohma R, Miyazaki T, et al. Comparison of activation process of platelets and neutrophils after coronary stent implantation versus balloon angioplasty for stable angina pectoris. Am J Cardiol 2000;86:1057-1062.
  • 10. Huczek Z, Filipiak KJ, Kochman J, et al. Baseline platelet size is increased in patients with acute coronary syndromes developing early stent thrombosis and predicts future residual platelet reactivity. A case-control study. Thromb Res 2010;125:406-412.
  • 11. Huczek Z, Kochman J, Filipiak KJ, et al. Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol 2005;46:284-290.
  • 12. Norgaz T, Hobikoglu G, Aksu H, et al. The relationship between preprocedural platelet size and subsequent in-stent restenosis. Acta Cardiol 2004;59:391-395.
  • 13. Ranjith MP, Divya R, Mehta VK, et al. Significance of platelet volume indices and platelet count in ischaemic heart disease. J Clin Pathol 2009;62:830-833.
  • 14. Vagdatli E, Gounari E, Lazaridou E, et al. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia 2010;14:28-32.
  • 15. Korovesis S, Fredericks S, Holt D, et al. Release of platelet activation markers during coronary angioplasty. Coron Artery Dis 2000;11:391-398.
  • 16. Purbiya P, Golwala ZM, Manchanda A, et al. Platelet Distribution Width to Platelet Count Ratio as an Index of Severity of Illness. Indian J Pediatr 2018;85:10-14.
  • 17. Golwala ZM, Shah H, Gupta N, et al. Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study. Afr Health Sci 2016;16:356-362.
  • 18. Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drugeluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2007;370:937-948.
  • 19. Inoue T, Croce K, Morooka T, et al. Vascular inflammation and repair: implications for re-endothelialization, restenosis, and stent thrombosis. JACC Cardiovasc Interv 2011;4:1057-1066.
  • 20. Gilbert J, Raboud J, Zinman B. Meta-analysis of the effect of diabetes on restenosis rates among patients receiving coronary angioplasty stenting. Diabetes Care 2004;27:990-994.
  • 21. Hong SJ, Kim MH, Ahn TH, et al. Multiple predictors of coronary restenosis after drug-eluting stent implantation in patients with diabetes. Heart 2006;92:1119-1124.
  • 22. Hu RT, Liu J, Zhou Y, et al. Association of smoking with restenosis and major adverse cardiac events after coronary stenting: A meta-analysis. Pak J Med Sci 2015;31:1002-1008.
  • 23. Singh M, Gersh BJ, McClelland RL, et al. Clinical and angiographic predictors of restenosis after percutaneous coronary intervention: insights from the Prevention of Restenosis With Tranilast and Its Outcomes (PRESTO) trial. Circulation 2004;109:2727-2731.
  • 24. Italiano JE Jr, Shivdasani RA. Megakaryocytes and beyond: the birth of platelets. J Thromb Haemost 2003;1:1174-1182.
  • 25. Ault KA, Rinder HM, Mitchell J, et al. The significance of platelets with increased RNA content (reticulated platelets). A measure of the rate of thrombopoiesis. Am J Clin Pathol 1992;98:637-646.
  • 26. Brown AS, Martin JF. The megakaryocyte platelet system and vascular disease. Eur J Clin Invest 1994;24(Suppl 1):9-15.
  • 27. Martin JF, Trowbridge EA, Salmon G, et al. The biological significance of platelet volume: its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration. Thromb Res 1983;32:443-460.
  • 28. T Thompson CB, Eaton KA, Princiotta SM, et al. Size dependent platelet subpopulations: relationship of platelet volume to ultrastructure, enzymatic activity, and function. Br J Haematol 1982;50:509-519.
  • 29. Grove EL, Hvas AM, Kristensen SD. Immature platelets in patients with acute coronary syndromes. Thromb Haemost 2009;101:151-156.
  • 30. Martin JF, Kristensen SD, Mathur A, et al. The causal role of megakaryocyteplatelet hyperactivity in acute coronary syndromes. Nat Rev Cardiol 2012;9:658-670.
  • 31. Freynhofer MK, Bruno V, Brozovic I, et al. Is increased platelet turnover responsible for low responsiveness to different thienopyridienes? A case report of recurrent stent thromboses. Thromb Haemost 2011;106:182-184.
  • 32. Grove EL, Hvas AM, Mortensen SB, et al. Effect of platelet turnover on whole blood platelet aggregation in patients with coronary artery disease. J Thromb Haemost 2011;9:185-191.
  • 33. Khode V, Sindhur J, Kanbur D, et al. Mean platelet volume and other platelet volume indices in patients with stable coronary artery disease and acute myocardial infarction: A case control study. J Cardiovasc Dis Res 2012;3:272-275.
  • 34. Kern A, Gil RJ, Bojko K, et al. Platelet distribution width as the prognostic marker in coronary bifurcation treatment. Eur J Clin Invest 2017;47:524-530.
  • 35. Ege MR, Guray U, Guray Y, et al. Platelet distribution width and saphenous vein disease in patients after CABG. Association with graft occlusion. Herz 2013;38:197-201.
  • 36. Ritchie JL, Harker LA. Platelet and fibrinogen survival in coronary atherosclerosis. Response to medical and surgical therapy. Am J Cardiol 1977;39:595-598.
  • 37. Khandekar MM, Khurana AS, Deshmukh SD, et al. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol 2006;59:146-149.
  • 38. Ferrante G, Niccoli G, Biasucci LM, et al. Association between C-reactive protein and angiographic restenosis after bare metal stents: an updated and comprehensive meta-analysis of 2747 patients. Cardiovasc Revasc Med 2008;9:156-165.
  • 39. Schoos MM, Kelbæk H, Kofoed KF, et al. Usefulness of preprocedure high-sensitivity C-reactive protein to predict death, recurrent myocardial infarction, and stent thrombosis according to stent type in patients with ST-segment elevation myocardial infarction randomized to bare metal or drug-eluting stenting during primary percutaneous coronary intervention. Am J Cardiol 2011;107:1597-1603.
  • 40. Carlquist JF, Knight S, Horne BD, et al. Cardiovascular risk among patients on clopidogrel anti-platelet therapy after placement of drug-eluting stents is modified by genetic variants in both the CYP2C19 and ABCB1 genes. Thromb Haemost 2013;109:744-754.
  • 41. Mao L, Jian C, Changzhi L, et al. Cytochrome CYP2C19 polymorphism and risk of adverse clinical events in clopidogrel-treated patients: a metaanalysis based on 23,035 subjects. Arch Cardiovasc Dis 2013;106:517-527
There are 41 citations in total.

Details

Primary Language English
Subjects Cardiology
Journal Section Articles
Authors

Firdevs Ayşenur Ekizler 0000-0002-3988-6828

Project Number -
Publication Date October 10, 2018
Published in Issue Year 2018 Volume: 71 Issue: 2

Cite

APA Ekizler, F. A. (2018). A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 71(2), 123-129. https://doi.org/10.4274/atfm.76476
AMA Ekizler FA. A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio. Ankara Üniversitesi Tıp Fakültesi Mecmuası. October 2018;71(2):123-129. doi:10.4274/atfm.76476
Chicago Ekizler, Firdevs Ayşenur. “A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71, no. 2 (October 2018): 123-29. https://doi.org/10.4274/atfm.76476.
EndNote Ekizler FA (October 1, 2018) A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71 2 123–129.
IEEE F. A. Ekizler, “A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 71, no. 2, pp. 123–129, 2018, doi: 10.4274/atfm.76476.
ISNAD Ekizler, Firdevs Ayşenur. “A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 71/2 (October 2018), 123-129. https://doi.org/10.4274/atfm.76476.
JAMA Ekizler FA. A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71:123–129.
MLA Ekizler, Firdevs Ayşenur. “A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 71, no. 2, 2018, pp. 123-9, doi:10.4274/atfm.76476.
Vancouver Ekizler FA. A Potantiel Marker of in-Stent Restenosis: Platelet Distribution Width/Platelet Ratio. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2018;71(2):123-9.
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