Reticulated Platelets Predict Cardiovascular Death and Adverse Events in Coronary Artery Disease: A Systematic Review and Meta-analysis

Author:

Chiarito Mauro1,Bernlochner Isabell23,Bongiovanni Dario412ORCID,Novelli Laura1ORCID,Condello Francesco1ORCID,Kirmes Kilian2,Han Jiaying2,Wein Bastian4,Elvinger Sébastien4,Viggiani Giacomo2,von Scheidt Moritz5,Laugwitz Karl-Ludwig23,Raake Philip W.J.4,Kastrati Adnan53ORCID

Affiliation:

1. Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy

2. Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany

3. German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany

4. Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany

5. Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany

Abstract

Background The pro-thrombotic immature or reticulated platelets (RPs) are known to be elevated in high-risk patients and in different pathological settings. It has been shown that RPs correlate with an insufficient antiplatelet response to antiplatelet agents. RPs are emerging novel predictors of adverse cardiovascular events in cardiovascular disease. This study, using the totality of existing evidence, evaluated the prognostic role of RPs in patients with coronary artery disease. Methods We performed a systematic review and meta-analysis including trials of acute and chronic coronary syndrome reporting clinical outcomes according to RPs levels in the peripheral blood. We compared patients with elevated RPs (RPshigh) to patients without elevated RPs (RPslow). Odds ratios (ORs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints were cardiovascular death, myocardial infarction, ischemic stroke, urgent coronary revascularization and bleedings. Results A total of 7 studies, including 2213 patients, were included. The risk for MACCE was significantly higher in RPshigh compared to RPslow patients (OR 2.67 [1.87; 3.81], I2  = 43.8%). RPshigh were associated with cardiovascular death (OR 2.09 [1.36; 3.22], I2  = 40.4%). No associations for RPshigh were detected with the other singular components of MACCE: myocardial infarction (OR 1.73 [0.89; 3.38] I2  = 60.5%) and stroke (OR 1.72 [0.59; 4.96] I2  = 21%). The risk of bleeding did not differ between groups(OR 0.58 [0.15; 2.22] I2  = 86.1%). Conclusion Elevated RPs are significantly associated with increased risk of cardiovascular events and cardiovascular death.

Publisher

Georg Thieme Verlag KG

Subject

Hematology

Reference33 articles.

1. Role of reticulated platelets in cardiovascular disease;D Bongiovanni;Arterioscler Thromb Vasc Biol,2022

2. Reticulated platelets predict cardiovascular death in acute coronary syndrome patients. Insights from the AMI-Florence 2 study;F Cesari;Thromb Haemost,2013

3. Association of immature platelets with adverse cardiovascular outcomes;H Ibrahim;J Am Coll Cardiol,2014

4. Platelet turnover predicts outcome after coronary intervention;M K Freynhofer;Thromb Haemost,2017

5. Immature platelet fraction: a new prognostic marker in acute coronary syndrome;R A López-Jiménez;Rev Esp Cardiol (Engl Ed),2013

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