Affiliation:
1. Evdokimov Moscow State University of Medicine and Dentistry, Moscow;
Davydovsky Municipal Clinical Hospital, Moscow
2. Evdokimov Moscow State University of Medicine and Dentistry, Moscow
Abstract
Aim To study the relationship of the platelet function and plasma homeostasis with the blood flow in the infarct-related artery (IRA) and with the course of acute myocardial infarction (AMI).Material and methods This study included 93 patients with AMI (75 patients with ST-elevation AMI and 18 patients without ST segment elevation). 63 patients had TIMI 0-1 blood flow in the IRA and 30 patients had TIMI 2–3. Rotational thromboelastometry, impedance aggregometry, the endothelium-dependent vasodilation (EDVD) test, and the thrombodynamics test were performed for all patients. The primary clinical endpoint included the totality of in-hospital complications of AMI, and the secondary endpoint included the totality of out-of-hospital complications of AMI. Major bleedings (BARC 3-5) and minor bleedings (BARC 1-2) were evaluated separately.Results Patients with IRA TIMI 0–1 flow were characterized by a shorter blood clotting time (BCT), larger thrombus size and density, more intense platelet aggregation induced by arachidonic acid and ADP, and lower values of the EDVD test. It was found that the parameters of platelet aggregation induced by arachidonic acid (AUC Asa) in combination with BCT allowed assessment of the severity of IRA blood flow disorder (sensitivity 76 %, specificity 71 %) in patients with AMI, regardless of the presence of ST segment elevation on the ECG. In addition, the incidence of the primary endpoint was greater in patients with IRA TIMI 0–1 flow (41.3% and 16.7%, respectively; p=0.015). In patients with TIMI 2–3 flow in the long-term period of the disease, the incidence of minor bleedings was significantly higher (8.5% and 30.4 %, respectively; p=0.045).Conclusion Compared to patients with preserved blood flow, patients with AMI and IRA TIMI 0–1 flow are characterized by endothelial dysfunction and more intense processes of thrombogenesis and platelet aggregation. It has been shown for the first time that the combination of two simple criteria for assessing hemostasis (AUC Asa; BCT) allows assessment of the degree of IRA blood flow disorder in patients with AMI.
Publisher
APO Society of Specialists in Heart Failure
Subject
Cardiology and Cardiovascular Medicine
Reference24 articles.
1. Alabas OA, Jernberg T, Pujades-Rodriguez M, Rutherford MJ, West RM, Hall M et al. Statistics on mortality following acute myocardial infarction in 842 897 Europeans. Cardiovascular Research. 2020;116(1):149–57. DOI: 10.1093/cvr/cvz197
2. Widimsky P, Crea F, Binder RK, Lüscher TF. The year in cardiology 2018: acute coronary syndromes. European Heart Journal. 2019;40(3):271–82. DOI: 10.1093/eurheartj/ehy904
3. Fefer P, Beigel R, Atar S, Aronson D, Pollak A, Zahger D et al. Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST-Elevation Acute Coronary Syndrome Undergoing Deferred Angiography. Journal of the American Heart Association. 2017;6(7):e004552. DOI: 10.1161/JAHA.116.004552
4. Stone GW, Cox D, Garcia E, Brodie BR, Morice M-C, Griffin J et al. Normal Flow (TIMI-3) Before Mechanical Reperfusion Therapy Is an Independent Determinant of Survival in Acute Myocardial Infarction: Analysis From the Primary Angioplasty in Myocardial Infarction Trials. Circulation. 2001;104(6):636–41. DOI: 10.1161/ hc3101.093701
5. Urazovskaya I.L., Skrypnik D.V., Vasilieva E.Yu., Shpektor A.V. Influence of the state of the endothelium on the possibility of spontaneous thrombolysis in patients with ST-elevation myocardial infarction. Creative Cardiology. 2008;1:36–8.
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