ABSTRACT

Objective:

Despite the transfer of the treatment process to pre-hospital settings, shortening of intervention times, and implementation of recommended treatment options, ST-elevation myocardial infarction (STEMI) remains the leading cause of in-hospital death. In our study, the contribution of the reperfusion strategy, clopidogrel loading doses, and adjunctive therapy on platelet aggregation to mortality and morbidity was investigated.

Material and Methods:

Between 2015-2016, 58 patients aged 18-80 years with a diagnosis of STEMI were included in the study. Peripheral venous blood samples were collected at 2^nd, 4^th, and 24^th hours after anti-platelet therapy to evaluate platelet functions. Patients were divided into two groups based on residual platelet aggregation levels in the 4^th-hour blood samples: those with aggregation level ≥47U were designated as group A, and those with <47U were designated as group B.

Results:

Our study revealed that patients with high residual platelet aggregation at the 4^th hour (group A) received fibrinolytic therapy, underwent a 300 mg clopidogrel loading dose, and used morphine due to persistent pain (p=0.003, p=0.036, p<0.001). It was found that inhospital events increased 6.637-fold in those who received fibrinolysis compared to those who did not [odds ratio (95% confidence interval): 6,637 (1,391-31,658), p=0.018]. When examining the effectiveness of morphine alone on platelet aggregation, it was observed that it was significantly associated with high residual platelet aggregation at 2^nd and 4^th hours, while this effect decreased at 24^th hour (p<0.001, p=0.070). No significant difference was observed in clinical outcomes related to high platelet reactivity.

Conclusion:

Based on the findings, the inadequacy of medical reperfusion strategy and delayed effect of clopidogrel with morphine use were detected. Although this delay did not have clinical significance, it led to a significant increase in hospital admissions with chest pain and the need for repeat revascularization during three-month follow-up. Long-term follow-up results are required.

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The Effect of Platelet Functions on Short-term Mortality and Morbidity in ST Elevation Myocardial Infarction

ABSTRACT

References