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Platelet activity in patients with patent vs. occluded bypass grafts. Prague-4 study subanalysis

Platelet activity in patients with patent vs. occluded bypass grafts. Prague-4 study subanalysis. P. Osman cik 1 , F. Bednar 2 , H. M o cikov a 3 , P. S tros 1 , K. Jirasek 2 , Z. Straka 2 , P. Widimsk y 1 1. Cardiocenter, Department of Cardiology, 3rd Medical School, Charles University

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Platelet activity in patients with patent vs. occluded bypass grafts. Prague-4 study subanalysis

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  1. Platelet activity in patients with patent vs. occluded bypass grafts. Prague-4 study subanalysis P. Osmancik1, F. Bednar2, H. Mocikova3, P. Stros1, K. Jirasek2, Z. Straka2, P. Widimsky1 1. Cardiocenter, Department of Cardiology, 3rd Medical School, Charles University and University Hospital Kralovske Vinohrady Prague, Czech Republic 2. Cardiocenter, Department of Cardiac Surgery, 3rd Medical School, Charles University and University Hospital Kralovske Vinohrady Prague, Czech Republic 3. Department of Clinical Hematology, University Hospital Kralovske Vinohrady Prague, Czech Republic

  2. No potential conflicts of interest

  3. Background • 10-years graft patency (studies from 80th): • 90% of arterial grafts (1) • 40-60% of vein grafts (1) • one-year graft patency (studies from 90th • and recent studies): • 91% - 98% of arterial grafts (2, 3) • 50% -65% of vein graft (2, 3) • 1. Lytle BW et al. Coronary Artery Bypass Surgery. Curr. Probl. Surg. 1992 • 2. Kim KB et al. Off-pump coronary artery bypass may decrease the patency of saphenous vein grafts. Ann Thorac Surg 2001 • 3. Widimsky P et al. One-year coronary bypass gaft patency. Circulation 2004

  4. Background • platelet activation during or shortly after PCI (higher platelet Gp IIb/IIIa expression) is associated with higher risk for the development of restenosis (1) • higher platelet activity before PCI (GpIIb/IIIa or P-selectin • platelet membrane expression) is associated by higher • restenosis rate (2, 3) • ?? the role of platelets in bypass graft occlusion • 1. Tschoeppe D. Platelet membrane activation markers are predicitive for increased risk of acute ischemic event after PTCA.Circulation 1993 • 2. Kabbani SS. Platelet reactivity characterized prosperity. A determinant of outcome 90 days after percutaneous coronary intervention. Circulation 2001 • 3. Murasaki K. High P-selectin expression and low CD36 occupancy on circulating platelets are strong predictors of • restenosis after coronary stenting in patients with coronary artery disease. Heart Vessels 2007

  5. Aim Is lower graft patency associated with higher platelet activity?

  6. Prague-4 trial • a prospective, randomised trial comparing off-pump and • on-pump coronary artery bypass surgery • no difference in one-year mortality • one-year coronary angiography performed in 255 pts. • Bypass graft patency (one year): • left internal mammary artery patency: • 91% on-pump vs. 91% off-pump (p=n.s.) • saphenous vein graft patency: • 59% on-pump vs. 49% off-pump (p=n.s.) • 1. Straka Z. et al. Off-pump versus on-pump coronary surgery: a final results from a prospective randomized study PRAGUE-4. • Ann Thorac Surg 2004 • Widimsky P et al. One-year coronary bypass gaft patency. A randomized comparison between off-pump and on-pump surgery. • Angiographic results of the PRAGUE-4 trial. Circulation 2004

  7. Patients • 80 patients from Prague-4 trial • 40 patients (closed) with at least one occluded graft at • one-year coronary angio (total graft count: 109, patency • rate 37%) • vs. • 40 patients (open) with all patent graft at one-year • coronary angio (total graft count: 97, patency rate:100%)

  8. Methods • fasting blood sample, pts. on chronic medication • membrane expression of platelet antigens by flow cytometry • CD41 PE (part of glycoprotein IIb/IIIa) (Immunotech), • expression as mean fluorescence intensity • CD 62P FITC (membrane P-selectin) (Immunotech), • expression as % of positive cells • - fixation with ThromboFix (TM) Platelet Stabiliser (Immunotech) • - cell analysis by Beckman Coulter flow cytometer • aggregability (optical aggregometry, 5 µLADP)

  9. Results (1) age gender diabetes EF LV (male) Closed 66.6+8.4 33(82%) 11 (29%) 57.3+10.4 Open 65.6+8.2 34(85%) 13(32.5%) 58.4+7.7 Statistics: chi-square or Student t-test, all differences not significant. EF LV: ejection fraction of left ventricle

  10. Results (2) aspirin warfarin statin insulin Closed 31(82%) 4 (10.5%) 34 (89%) 3 (7.9%) Open 37(92.5%) 2(5%) 36(90%) 1(2.5%) Statistics: chi-square or Fisher´exact test

  11. Results (3) Data are displayed as median + 5-95 percentile. Statistics performed by Wilcoxon test.

  12. Results (4) Data are displayed as median + 5-95 percentile. Statistics performed by Wilcoxon test.

  13. Results (5) r = 0,6, p < 0,01 Statistical analysis by Spearman correlation.

  14. Conclusion (1) • platelet activity correlates with fasting glycaemia • higher triglyceride level are corelated with • higher platelet activity • metabolic syndrome is accopanied by higher activity of platelets

  15. Conclusion(2) • platelet activity does not differ between patients with • patent vs. occluded bypass grafts • other factors than platelet activity may play more • important role in the pathophysiology of bypass graft • occlusion, at least in the follow-up up to one year • after surgery

  16. Thank you for attention !

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