Role of activation-dependent platelet membrane glycoproteins in development of subacute occlusive coronary stent thrombosis.

Abstract

BACKGROUND:

Platelets have an important role in coronary thrombosis.

METHODS:

We studied 151 consecutive patients undergoing implantation of Palmaz-Schatz stents because of suboptimal results after coronary balloon angioplasty treated by intense anticoagulation. Surface exposure of the constitutively expressed glycoprotein complex IIb-IIIa (CD41), P-selectin (CD62P) and of the GPIIb-IIIa complex activated exposure (of ligand-induced binding site-1) were determined, in addition to platelet count and plasma fibrinogen, before and daily for 12 days after stenting in peripheral venous blood samples.

RESULTS:

Six of 151 patients (3.9%) developed subacute stent thrombosis within the first week after stenting. The relative risk of stent thrombosis was 18.5-fold for patients with enhanced GPIIb-IIIa surface expression (P < 0.003; 95% confidence interval 2.1 to 163.1) before stent placement. In the period after stenting, platelet activation occurred, with an increase in fibrinogen receptor activity and P-selectin degranulation above pre-stent values (P < 0.01). In logistic regression analysis, GPIIb-IIIa before stenting emerged as a risk factor for stent thrombosis, independent of the activational status of platelets, platelet count or fibrinogen levels (P < 0.02). However, after stenting, P-selectin surface expression acquired prognostic importance for stent thrombosis (P < 0.05).

CONCLUSION:

We conclude that changes in platelet membrane glycoproteins are of prognostic value in predicting subacute stent thrombosis.

• Authors: M Gawaz, F J Neumann, I Ott, A May, S Rüdiger, A Schömig
• Journal: Coronary artery disease (Coron Artery Dis) 1997 Mar-Apr Vol. 8 Issue 3-4 Pg. 121-8 ISSN: 0954-6928 [Print] England
• PMID: 9237020 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• P-Selectin
• Platelet Glycoprotein GPIIb-IIIa Complex

Topics

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Angioplasty, Balloon, Coronary (adverse effects, methods)
• Coronary Disease (therapy)
• Coronary Thrombosis (blood, etiology)
• Female
• Follow-Up Studies
• Graft Occlusion, Vascular (blood, complications)
• Humans
• Male
• Middle Aged
• P-Selectin (biosynthesis, blood)
• Platelet Activation (physiology)
• Platelet Glycoprotein GPIIb-IIIa Complex (biosynthesis, metabolism, physiology)
• Prospective Studies
• Stents (adverse effects)