Relationship of comorbidity and platelet function in patients with unstable angina

Background. Platelets play a key role in the pathogenesis of acute coronary syndrome (ACS). In recent years, the amount of data on the advisability of using the platelet function test (PFT) in the appointment of antithrombotic therapy has been growing.

Objective. To access PFT in patients with unstable angina and various comorbidities.

Design and methods. The study involved 74 patients with the diagnosis of unstable angina. All patients underwent standard clinical examination, PFT (impedance aggregometry with ADP and collagen), assessment of Charlson comorbidity index.

Results. The most frequent comorbidities were: hypertension (95 %), type 2 diabetes mellitus (30 %), excessive body weight (35 %), multifocal atherosclerosis (22 %), smoking (24 %). Half of the patients (n = 36) had high level of comorbidity. Patients with a comorbidity index of 5 or more had high platelet aggregation on the 3rd day of hospitalization. Elderly patients, smokers, as well as patients with diabetes mellitus type 2 and multifocal atherosclerosis also had higher values of platelet activity, which may be associated with unfavorable prognosis and risk of recurrent events.

Conclusion. We revealed association between PFT and comorbidities both with risk factors or diseases alone and in its integral assessment using the Charlson comorbidity index. Among the individual risk factors, smoking, diabetes mellitus and multifocal atherosclerosis were the most important, which confirms their direct role in the pathogenesis of thrombotic complications.

1. Tyagi, T., Jain, K., Gu, S.X. et al. A guide to molecular and functional investigations of platelets to bridge basic and clinical sciences. Nat Cardiovasc Res. 2022; 1:223–237. https://doi.org/10.1038/s44161-022-00021-z

2. Franchi, F., Angiolillo, D. Novel antiplatelet agents in acute coronary syndrome. Nat Rev Cardiol 2015; 12:30–47. https://doi.org/10.1038/nrcardio.2014.156

3. Mangieri A, Gallo F, Sticchi A, Khokhar AA, Laricchia A, Giannini F, Colombo A. Dual antiplatelet therapy in coronary artery disease: from the past to the future prospective. Cardiovasc Interv Ther. 2020; 35(2):117-129. doi: 10.1007/s12928-020-00642-w.

4. Collet J., Thiele H., Barbato E., Barthélémy O. et al. Rekomendacii ESC po vedeniyu pacientov s ostrym koronarnym sindromom bez stojkogo pod"ema segmenta ST 2020. Rossijskij kardiologicheskij zhurnal. 2021;26(3):4418. https://doi.org/10.15829/1560-4071-2021-4418

5. Passacquale, G., Sharma, P., Divaka Perera, Ferro, Albert, Ferro, A. Antiplatelet therapy in cardiovascular disease: Current status and future directions. 2022; 88(6): 2477-3003. https://doi.org/10.1111/bcp.15221

6. Mattia Galli Dominick J Angiolillo. De-escalation of antiplatelet therapy in acute coronary syndromes: Why, how and when? Frontiers in Cardiovascular Medicine. 2022; 9:1-13. DOI: 10.3389/fcvm.2022.975969

7. Sibbing D. et al. Updated Expert Consensus Statement on Platelet Function and Genetic Testing for Guiding P2Y 12 Receptor Inhibitor Treatment in Percutaneous Coronary Intervention. JACC. Cardiovasc. Interv. JACC Cardiovasc Interv. 2019; 12(16):1521–1537. 10.1016/J.JCIN.2019.03.034

8. Charlson, M.E., Carrozzino D., Guidi G et al. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. Psychother Psychosom. 2022; 91:8–35 DOI: 10.1159/000521288

9. Batista, T. R., de Figueiredo, R. C., Rios, D. R. A. Platelets volume indexes and cardiovascular risk factors. Revista Da Associacao Medica Brasileira. 2018; 64(6):554–559. https://doi.org/10.1590/1806-9282.64.06.554

10. Barale, C., Russo, I. Influence of Cardiometabolic Risk Factors on Platelet Function. International Journal of Molecular Sciences. 2020: 21(2). https://doi.org/10.3390/IJMS21020623

11. José Gildo de Moura Monteiro Júnior , Dilênia de Oliveira Cipriano Torres, Dário Celestino Sobral Filho. Hematological Parameters as Prognostic Biomarkers in Patients with Cardiovascular Diseases. Current Cardiology Reviews. 2019;15(4): 274-282. https://doi.org/10.2174/1573403X15666190225123544

12. Stojko O.A., SHalaev S.V. Kliniko-prognosticheskoe znachenie rezidual'noj aktivnosti trombocitov u bol'nyh OKS bez pod"emov segmenta ST. Kardiologiya. 2019;59(7S):40–46.

13. Renato V., Rossella M, Davide C. et al. Residual platelet reactivity to predict long-term clinical outcomes after clopidogrel loading in patients with acute coronary syndromes: comparison of different cutoff values by light transmission aggregometry from the responsiveness to clopidogrel and stent thrombosis 2-acute coronary syndrome (RECLOSE 2-ACS) study. J Thromb Thrombolysis/ 2015; 40:76–82. DOI 10.1007/s11239-014-1159-1

14. Stone GW, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann F-J, Metzger DC et al. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. The Lancet. 2013;382(9892):614–23. DOI: 10.1016/S0140-6736(13)61170-8

15. Lomakin N. V., Buryachkovskaya L. I., Sumarokov A. B., Gabbasov Z. A., Gerasimov A. N. Vzaimosvyaz' funkcional'noj aktivnosti trombocitov s prognozom neblagopriyatnyh serdechno-sosudistyh sobytij u bol'nyh ostrym koronarnym sindromom. Rezul'taty registrovogo issledovaniya. Kardiologiya. 2019; 59(10):5–13

16. Van Der Sangen N.M.R. et al. Patient-tailored antithrombotic therapy following percutaneous coronary intervention. Eur. Heart J. 2021; 42(10): 1038–1046.

17. Udaya S Tantry, Saroj Timilsina, Amit Rout, Kevin Bliden, Paul A Gurbel. Assessing platelet reactivity after drug eluting stent implantation: state of the art. ExpertReview of Cardiovascular Therapy. 2020; 18. DOI: 10.1080/14779072.2020.1724536

18. L.I. Malinova, N.V. Furman, P.V. Dolotovskaya i soavt. Antiagregantnaya terapiya pri ostrom koronarnom sindrome s pod"emom segmenta ST v usloviyah real'noj klinicheskoj praktiki: dinamika funkcional'noj aktivnosti trombocitov. Rossijskij kardiologicheskij zhurnal. 2017; 1 (141): 82–88. http://dx.doi.org/10.15829/1560-4071-2017-1-82-88

19. Roland Klingenberg et al. Residual inflammatory risk at 12 months after acute coronary syndromes is frequent and associated with combined adverse events. Atherosclerosis. 2021; 320: 31–37.

20. Trevor Simard, et al. Modifiable Risk Factors and Residual Risk Following Coronary Revascularization: Insights From a Regionalized Dedicated Follow-Up Clinic. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2021; 5(6):1138-1152. https://doi.org/10.1016/j.mayocpiqo.2021.09.001