Published Online
on August 16, 2004

A more recent version of this article appeared on September 14, 2004

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Submitted on February 13, 2004
Revised on May 13, 2004
Accepted on May 21, 2004

Platelet Function Predicts Myocardial Damage in Patients With Acute Myocardial Infarction

Martin Frossard MD, Ingrid Fuchs MD, Judith M. Leitner MD, Kety Hsieh MD, Marianne Vlcek MD, Heidrun Losert MD, Hans Domanovits MD, Wolfgang Schreiber MD, Anton N. Laggner MD, and Bernd Jilma MD^*

From the Departments of Clinical Pharmacology (I.F., J.M.L., K.S., B.J.) and Emergency Medicine (M.F., I.F., M.V., H.L., H.D., W.S., A.N.L.), Medical University, Vienna, Austria.

^* To whom correspondence should be addressed. E-mail: bernd.jilma{at}meduniwien.ac.at.

Background--Platelet activation is a hallmark of acute coronary syndromes. Numerous lines of evidence suggest a mechanistic link between von Willebrand factor or platelet hyperfunction and myocardial damage in patients with acute coronary syndromes. Thus, we assessed whether platelet function under high shear rates (collagen adenosine diphosphate closure times [CADP-CTs]) measured with the platelet function analyzer (PFA-100) may be enhanced in patients with myocardial infarction (MI) and whether it may predict the extent of myocardial damage as measured by creatine kinase (CK-MB) or troponin T (TnT) levels.

Methods and Results--Patients with acute chest pain or symptoms suggestive of acute coronary syndromes (n=216) were prospectively examined at an emergency department. CADP-CT was significantly shorter in patients with MI, particularly in those with an ST-segment-elevation MI (STEMI) compared with the other patient groups (unstable angina, stable coronary artery disease, or controls). Furthermore, CADP-CT and collagen epinephrine-CT at presentation were independent predictors of myocardial damage as measured by CK-MB or TnT. Patients with MI whose CADP-CT values fell in the first quartile had 3-fold higher CK-MB and TnT levels than those in the fourth quartile.

Conclusions--Patients with STEMI have significantly enhanced platelet function when measured under high shear rates. CADP-CT is an independent predictor of the severity of MI, as measured by markers of cardiac necrosis. Measurement of platelet function with the PFA-100 may help in the risk stratification of patients presenting with MI.

Key words: platelets • myocardial infarction • creatine kinase • collagen

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