VISCOSE AND THROMBOCYTIC-AGGREGATION DISORDERS ON PATIENTS WITH MYOCARDIAL INFARCTION WITH STABLE ELEMENTATION OF ST SEGMENT
Article PDF (Українська)

Keywords

treatment-diagnostic approaches, blood circulation, hyperviscosity and hypercoagulability syndromes, atheromatous process, platelets

Abstract views: 18
PDF Downloads: 1

How to Cite

Uzun , D., Lazoryshynets , V., & Uzun K.S., K. (2021). VISCOSE AND THROMBOCYTIC-AGGREGATION DISORDERS ON PATIENTS WITH MYOCARDIAL INFARCTION WITH STABLE ELEMENTATION OF ST SEGMENT. Medical Science of Ukraine (MSU), 17(4). https://doi.org/10.32345/2664-4738.4.2021.05

Abstract

Relevance. Clinical studies indicate a significant role in the pathogenesis of acute myocardial infarction, the functional state of platelet aggregation and blood viscosity, which determine the nature of blood flow in the vessels at the level of macro– and microcirculation.

Objective: the aim of the study was to analyze changes in viscosity and platelet-aggregation disorders under the influence of different tactical, diagnostic and interventional approaches in patients with myocardial infarction and stable elevation of the ST segment in the presence of multivascular coronary artery disease.

Materials and methods. Patient inclusion criteria for the study: MI with persistent ST-segment elevation; multi-vascular atherosclerotic coronary artery disease; angiographically significant stenosis of the coronary vessels more than 50-70%, at least in 2 projections; functionally significant stenosis of the coronary arteries, according to the fractional blood flow reserve (FBFR) (<0.80). 102 patients were divided into 4 groups of the same type. The groups used 4 different tactical and treatment-diagnostic approaches. Group 1 (n = 25) - occlusion of an infarct-dependent vessel was detected using coronary angiography and its immediate stenting was performed; FBFR was established on days 2-3, and stenosis of infarction-independent arteries was proved; using optical coherence tomography (OCT), the stability, size, length of atheroma was assessed and delayed stenting of these vessels was performed. Group 2 (n = 26) - stenting of the infarct-dependent artery was performed; FBFR was established on days 2-3, but without OCT, followed by stenting of infarct-independent arteries. Group 3 (n = 25) - carried out simultaneous stenting of infarct-dependent and infarct-independent vessels after coronary angiography. Group 4 (n = 26) - only stenting of the infarct-dependent vessel was performed. All patients received standard two-component antiplatelet therapy (acetylsalicylic acid 75-150 mg/day and clopidogrel 75 mg/day) and received 20 mg of atorvastatin and 10 mg of ezetimibe. The results obtained in patients were compared with those results obtained in 30 practically healthy people of the same age and gender. The number of platelets and the concentration of fibrinogen were determined in each subject. Using a viscometer and a laser aggregometer the degree of platelet adhesion, the time of platelet adhesion, the degree of platelet aggregation, and blood viscosity were assessed. All indicators were studied three times - on the first day of myocardial infarction, after 3-4 weeks, and after a year. 

Results. Hyperviscous and hypercoagulable syndromes were established in patients with MI with persistent ST-segment elevation. They manifested themselves in the first weeks by a compensatory increase in the number of platelets, blood viscosity, fibrinogen levels, and an increase in platelet aggregation. Delayed stenting of infarct-independent arteries used in group 1 contributed to a lower amplitude of fluctuations of all laboratory parameters in comparison with other tactical and therapeutic approaches.

Conclusions.  It is possible to optimize the state of viscosity and the processes of adhesion/aggregation of platelets due to the systemic stepwise improvement of arterial blood supply. Traditional tactical and therapeutic-diagnostic principles of management of such category of patients do not fundamentally improve the state of viscous and coagulation-aggregation parameters even when using double antiplatelet therapy.

https://doi.org/10.32345/2664-4738.4.2021.05
Article PDF (Українська)

References

Gabbasov ZA, Ryzhkova EV. Platelet phenotype and myocardial infarction. Creative Cardiology. 2014; 2: 48-59. [in Russian]

View at:

Publisher Site: https://cardiology-journal.com/catalog/detail.php?SECTION_ID=971&ID=18348

URL: http://heart-master.com/wp-content/uploads/2014/10/2014_02_48-59.pdf

Nikiforov VS. Blood viscosity as a target of therapeutic effects in cardiovascular pathology. Farmateka. 2015; 13: 59-62. [in Russian]

View at:

Publisher Site: https://pharmateca.ru/ru/archive/article/31900

Koryakina LB, Pivovarov Yu.I, Kurilskaya TE, Sergeeva AS, Babushkina IV. Dysfunction of the vascular endothelium in arterial hypertension and coronary heart disease (literature review). Bulletin of the All-Russian Scientific Center of the Siberian Branch of the Russian Academy of Medical Sciences. 2013; 2(90): 165-70. [in Russian]

View at:

Publisher Site: https://www.actabiomedica.ru/jour/article/view/1550?locale=ru_RU

PubMed: https://cyberleninka.ru/article/n/disfunktsiya-sosudistogo-endoteliya-pri-arterialnoy-gipertonii-i-ishemicheskoy-bolezni-serdtsa-obzor-literatury

Cowan AQ, Cho DJ, Rosenson RS. Importance of blood rheology in the pathophysiology of atherothrombosis. Cardiovascular Drugs and Therapy. 2012; 26: 339-48. DOI: 10.1007/s10557-012-6402-4

View at:

Scopus: https://link.springer.com/article/10.1007%2Fs10557-012-6402-4

PubMed: https://pubmed.ncbi.nlm.nih.gov/22821616/

Lysenko GI, Tkachenko VI. The role of clopidogrel in the prevention of cardiovascular catastrophes. The art of healing. 2011; 3(79): 58-63. [in Russian]

View at:

URL: https://www.health-medix.com/articles/misteztvo/2011-04-11/11GILSSK.pdf

Bonin M, Mewton N, Roubille F, Morel O, Cayla G, Angoulvant D, Elbaz M, Claeys MJ, Garcia-Dorado D, Giraud C, Rioufol G, Jossan C, Ovize M, Guerin P and CIRCUS Study Investigators. Effect and safety of morphine use in acute anterior ST-segment elevation myocardial infarction. Journal of the American Heart Association. 2018; 7(4): e006833. DOI: 10.1161/JAHA.117.006833

View at:

Publisher Site: https://www.ahajournals.org/doi/10.1161/JAHA.117.006833

PubMed: https://pubmed.ncbi.nlm.nih.gov/29440010/

PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850179/

Harrington DH, Stueben F, Lenahan CM. ST-elevation myocardial infarction and non-ST-elevation myocardial infarction: Medical and surgical interventions. Critical Care Nursing Clinics of North America. 2019; 31(1): 49-64. DOI: 10.1016/j.cnc.2018.10.002

View at:

Scopus: https://www.sciencedirect.com/science/article/abs/pii/S0899588518310001?via%3Dihub

PubMed: https://pubmed.ncbi.nlm.nih.gov/30736935/

Baek JY, Kang TS, Rha S-W, Choi BG, Park SH, Jeong MH. Twelve-month clinical outcomes of acute non-ST versus ST-segment elevation myocardial infarction patients with reduced preprocedural thrombolysis in myocardial infarction flow undergoing percutaneous coronary intervention. Coronary Artery Disease. 2018; 29(5): 416-22. DOI: 10.1097/MCA.0000000000000632

View at:

Publisher Site: https://journals.lww.com/coronary-artery/Abstract/2018/08000/Twelve_month_clinical_outcomes_of_acute_non_ST.12.aspx

PubMed: https://pubmed.ncbi.nlm.nih.gov/29708887/

Labelle M, Begum S, Hynes RO. Direct signaling between platelets and cancer cells induces an epithelial-mesenchymal-like transition and promotes metastasis. Cancer Cell. 2011; 20(5): 576-90. DOI: 10.1016/j.ccr.2011.09.009

View at:

Publisher Site: https://www.cell.com/cancer-cell/fulltext/S1535-6108(11)00356-4

PubMed: https://pubmed.ncbi.nlm.nih.gov/22094253/

PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487108/

Yang SH, Du Y, Zhang Y, Li X-L, Li S, Xu R-X, Zhu C-G, Guo Y-L, Wu N-Q, Qing P, Gao Y, Cui C-J, Dong Q, Sun J, Li J-J. Serum fibrinogen and cardiovascular events in Chinese patients with type 2 diabetes and stable coronary artery disease: a prospective observational study. British Medical Journal. 2017; 7(6): 123-5. DOI: 10.1136/bmjopen-2016-015041

View at

Publisher Site: https://bmjopen.bmj.com/content/7/6/e015041

PubMed: https://pubmed.ncbi.nlm.nih.gov/28601829/

PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734258/

Lievens D, von Hundelshausen P. Platelets in atherosclerosis. Thromb. Haemost. 2011; 106(5): 827-38. DOI: 10.1160/TH11-08-0592

View at:

Publisher Site: https://www.thieme-connect.de/products/ejournals/abstract/10.1160/TH11-08-0592

PubMed: https://pubmed.ncbi.nlm.nih.gov/22012554/

Pandey AK, Duong T, Swiatkiewicz I, Daniels LB. A comparison of biomarker rise in type 1 and type 2 myocardial infarction. American Journal of Medicine. 2020; 133(10): 1203-8. DOI: 10.1016/j.amjmed.2020.02.024

View at:

Publisher Site: https://www.amjmed.com/article/S0002-9343(20)30211-4/fulltext

PubMed: https://pubmed.ncbi.nlm.nih.gov/32234496/

András J, Erdős G, Péter FP, Forster T, Ungi I, Ofner P, Andréka P. Prognostic significance of the total ischemic time in patients with ST-elevation myocardial infarction. Orvosi Hetilap. 2018; 159(27): 1113-20. [in Hu]. DOI: 10.1556/650.2018.31108.

View at:

Publisher Site: https://akjournals.com/view/journals/650/159/27/article-p1113.xml

PubMed: https://pubmed.ncbi.nlm.nih.gov/29961371/

Caimi G, Hopps E, Montana M, Andolina G, Urso C, Canino B, Lo Presti R. Analysis of the blood viscosity behavior in the Sicilian study on juvenile myocardial infarction. Clinical and Applied Thrombosis/Hemostasis. 2018; 24(8): 1276-81. doi: 10.1177/1076029618775511

View at:

Publisher Site: https://journals.sagepub.com/doi/10.1177/1076029618775511

PubMed: https://pubmed.ncbi.nlm.nih.gov/29792062/

PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714779/

Clemetson KJ. Platelet receptors. In: A.D. Michelson (Ed.), Platelets (pp. 169-194). San Diego: Elsevier Academic Press, 2013. – 1400 p.

View at:

Scopus: https://www.elsevier.com/books/platelets/michelson/978-0-12-387837-3

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.