The role of global thrombosis in patients undergoing percutaneous coronary intervention (PCI)

Abstract

Coronary artery disease (CAD) is a leading cause of mortality worldwide, despite great efforts in designing several risk stratification models for more effective prevention of related complications and creating more advanced treatment methods. Furthermore, the average age of affected patients observed recently, is significantly lower compared to previous decades and potential complications remain devastating. In recent years, the global thrombosis test (GTT), which is a novel test assessing clot formation/thrombosis and subsequent endogenous thrombolysis (ET) under physiological conditions, has been used in several studies of patients with acute coronary syndrome (ACS), providing us with valuable information. This test is unique, as it is currently the only test of its kind, able to assess individual ET, which according to these studies can predict cardiovascular death and non-fatal myocardial infarction (MI) in ACS patients. However, stable angina patients and patients with MI undergoing primary percutaneous coronary intervention (PPCI), the most critically affected CAD patients, had not been previously investigated, therefore this enabled us to design a study investigating fields never been previously explored, with the prospect of presenting data that could stimulate further research and enhance future management of patients with cardiovascular disease. We successfully demonstrated that individual ET status can predict major adverse cardiovascular events (MACE) following PPCI. Furthermore, we showed that increased individual platelet reactivity before PPCI, is related to non-fatal MI, which had not been shown in previous studies of global thrombosis. In the group of non-ST elevation myocardial infarction (NSTEMI) patients, we observed significant relationship between ET and peak Troponin level, which is a marker of the size of myocardial damage, resulting from lasting coronary thrombus. Finally, we demonstrated that the medication vorapaxar, which is a direct thrombin inhibitor, can enhance ET and could be proven to be beneficial when administered in certain patients, for the prevention of future adverse cardiovascular events. The main limitation identified in all sub-studies, was the small patient number, therefore in view of the positive results demonstrated in our study, larger scale studies should be carried out, aiming to reinforce the vital role of global thrombosis assessment in patients with CAD.