Point-of-care determination of baseline platelet function as a predictor of clinical outcomes in patients who present to the Emergency Department with Chest Pain

Carrie Lynn Selvaraj, Eric John Van De Graaff, Charles Campbell, Brad S. Abels, John P. Marshall, Steven R. Steinhubl

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Increased platelet reactivity can identify patients at high risk for thrombotic events, but its clinical use has been impractical due to technical limitations. The purpose of the present study is to determine if a point-of-care measurement of platelet function in patients presenting to an emergency room with chest pain can identify those at high risk of adverse cardiac events. Methods: Platelet function was measured using the Ultegra-RPFA in 201 patients presenting to the emergency department with the primary complaint of chest pain and either known coronary disease or at least one cardiac risk factor. The primary endpoint was any major adverse cardiac events (MACE) [cardiac death, myocardial infarction (MI), re-admission for coronary revascularization] 6 months post-enrollment. Results: Platelet function at baseline ranged from 44 to 315 platelet activation units (PAU) (mean 175±6). Seventy-six patients experienced MACE (37.8%) by 6 months post-enrollment. Mean PAU was significantly lower in the group experiencing MACE (166±9 vs. 181±9; p = 0.026). By univariate analysis, admission PAU was a significant predictor of MACE at 6 months (p = 0.028). However, when adjusted for age, gender, cardiac risk factors, and a history of coronary artery disease (CAD) using multivariate logistic regression analysis, PAU was no longer significantly predictive of MACE (p = 0.268). Conclusions: Point-of-care testing of platelet function deserves further study for risk assessment and individualized therapy in the future. Abbreviated Abstract. Platelet function was assessed in 201 patients presenting to the emergency department with chest pain using a point-of-care device to measure platelet activation, the Ultegra-RPFA. Platelet function, expressed in platelet activation units (PAU), was significantly lower in patients who experienced adverse cardiac events (p = 0.026). By univariate analysis, PAU was a significant predictor of cardiac death, MI, and re-hospitalization for revascularization at 6 months (p = 0.028). However, when adjusted for age, gender, cardiac risk factors, and coronary artery disease (CAD), PAU was no longer significantly predictive of the above combined endpoint (p = 0.268).

Original languageEnglish (US)
Pages (from-to)109-115
Number of pages7
JournalJournal of Thrombosis and Thrombolysis
Volume18
Issue number2
DOIs
StatePublished - Oct 1 2004
Externally publishedYes

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Point-of-Care Systems
Platelet Activation
Chest Pain
Hospital Emergency Service
Blood Platelets
Coronary Artery Disease
Myocardial Infarction
Coronary Disease
Hospitalization
Logistic Models
Regression Analysis
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

Point-of-care determination of baseline platelet function as a predictor of clinical outcomes in patients who present to the Emergency Department with Chest Pain. / Selvaraj, Carrie Lynn; Van De Graaff, Eric John; Campbell, Charles; Abels, Brad S.; Marshall, John P.; Steinhubl, Steven R.

In: Journal of Thrombosis and Thrombolysis, Vol. 18, No. 2, 01.10.2004, p. 109-115.

Research output: Contribution to journalArticle

Selvaraj, Carrie Lynn ; Van De Graaff, Eric John ; Campbell, Charles ; Abels, Brad S. ; Marshall, John P. ; Steinhubl, Steven R. / Point-of-care determination of baseline platelet function as a predictor of clinical outcomes in patients who present to the Emergency Department with Chest Pain. In: Journal of Thrombosis and Thrombolysis. 2004 ; Vol. 18, No. 2. pp. 109-115.
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abstract = "Background: Increased platelet reactivity can identify patients at high risk for thrombotic events, but its clinical use has been impractical due to technical limitations. The purpose of the present study is to determine if a point-of-care measurement of platelet function in patients presenting to an emergency room with chest pain can identify those at high risk of adverse cardiac events. Methods: Platelet function was measured using the Ultegra-RPFA in 201 patients presenting to the emergency department with the primary complaint of chest pain and either known coronary disease or at least one cardiac risk factor. The primary endpoint was any major adverse cardiac events (MACE) [cardiac death, myocardial infarction (MI), re-admission for coronary revascularization] 6 months post-enrollment. Results: Platelet function at baseline ranged from 44 to 315 platelet activation units (PAU) (mean 175±6). Seventy-six patients experienced MACE (37.8{\%}) by 6 months post-enrollment. Mean PAU was significantly lower in the group experiencing MACE (166±9 vs. 181±9; p = 0.026). By univariate analysis, admission PAU was a significant predictor of MACE at 6 months (p = 0.028). However, when adjusted for age, gender, cardiac risk factors, and a history of coronary artery disease (CAD) using multivariate logistic regression analysis, PAU was no longer significantly predictive of MACE (p = 0.268). Conclusions: Point-of-care testing of platelet function deserves further study for risk assessment and individualized therapy in the future. Abbreviated Abstract. Platelet function was assessed in 201 patients presenting to the emergency department with chest pain using a point-of-care device to measure platelet activation, the Ultegra-RPFA. Platelet function, expressed in platelet activation units (PAU), was significantly lower in patients who experienced adverse cardiac events (p = 0.026). By univariate analysis, PAU was a significant predictor of cardiac death, MI, and re-hospitalization for revascularization at 6 months (p = 0.028). However, when adjusted for age, gender, cardiac risk factors, and coronary artery disease (CAD), PAU was no longer significantly predictive of the above combined endpoint (p = 0.268).",
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T1 - Point-of-care determination of baseline platelet function as a predictor of clinical outcomes in patients who present to the Emergency Department with Chest Pain

AU - Selvaraj, Carrie Lynn

AU - Van De Graaff, Eric John

AU - Campbell, Charles

AU - Abels, Brad S.

AU - Marshall, John P.

AU - Steinhubl, Steven R.

PY - 2004/10/1

Y1 - 2004/10/1

N2 - Background: Increased platelet reactivity can identify patients at high risk for thrombotic events, but its clinical use has been impractical due to technical limitations. The purpose of the present study is to determine if a point-of-care measurement of platelet function in patients presenting to an emergency room with chest pain can identify those at high risk of adverse cardiac events. Methods: Platelet function was measured using the Ultegra-RPFA in 201 patients presenting to the emergency department with the primary complaint of chest pain and either known coronary disease or at least one cardiac risk factor. The primary endpoint was any major adverse cardiac events (MACE) [cardiac death, myocardial infarction (MI), re-admission for coronary revascularization] 6 months post-enrollment. Results: Platelet function at baseline ranged from 44 to 315 platelet activation units (PAU) (mean 175±6). Seventy-six patients experienced MACE (37.8%) by 6 months post-enrollment. Mean PAU was significantly lower in the group experiencing MACE (166±9 vs. 181±9; p = 0.026). By univariate analysis, admission PAU was a significant predictor of MACE at 6 months (p = 0.028). However, when adjusted for age, gender, cardiac risk factors, and a history of coronary artery disease (CAD) using multivariate logistic regression analysis, PAU was no longer significantly predictive of MACE (p = 0.268). Conclusions: Point-of-care testing of platelet function deserves further study for risk assessment and individualized therapy in the future. Abbreviated Abstract. Platelet function was assessed in 201 patients presenting to the emergency department with chest pain using a point-of-care device to measure platelet activation, the Ultegra-RPFA. Platelet function, expressed in platelet activation units (PAU), was significantly lower in patients who experienced adverse cardiac events (p = 0.026). By univariate analysis, PAU was a significant predictor of cardiac death, MI, and re-hospitalization for revascularization at 6 months (p = 0.028). However, when adjusted for age, gender, cardiac risk factors, and coronary artery disease (CAD), PAU was no longer significantly predictive of the above combined endpoint (p = 0.268).

AB - Background: Increased platelet reactivity can identify patients at high risk for thrombotic events, but its clinical use has been impractical due to technical limitations. The purpose of the present study is to determine if a point-of-care measurement of platelet function in patients presenting to an emergency room with chest pain can identify those at high risk of adverse cardiac events. Methods: Platelet function was measured using the Ultegra-RPFA in 201 patients presenting to the emergency department with the primary complaint of chest pain and either known coronary disease or at least one cardiac risk factor. The primary endpoint was any major adverse cardiac events (MACE) [cardiac death, myocardial infarction (MI), re-admission for coronary revascularization] 6 months post-enrollment. Results: Platelet function at baseline ranged from 44 to 315 platelet activation units (PAU) (mean 175±6). Seventy-six patients experienced MACE (37.8%) by 6 months post-enrollment. Mean PAU was significantly lower in the group experiencing MACE (166±9 vs. 181±9; p = 0.026). By univariate analysis, admission PAU was a significant predictor of MACE at 6 months (p = 0.028). However, when adjusted for age, gender, cardiac risk factors, and a history of coronary artery disease (CAD) using multivariate logistic regression analysis, PAU was no longer significantly predictive of MACE (p = 0.268). Conclusions: Point-of-care testing of platelet function deserves further study for risk assessment and individualized therapy in the future. Abbreviated Abstract. Platelet function was assessed in 201 patients presenting to the emergency department with chest pain using a point-of-care device to measure platelet activation, the Ultegra-RPFA. Platelet function, expressed in platelet activation units (PAU), was significantly lower in patients who experienced adverse cardiac events (p = 0.026). By univariate analysis, PAU was a significant predictor of cardiac death, MI, and re-hospitalization for revascularization at 6 months (p = 0.028). However, when adjusted for age, gender, cardiac risk factors, and coronary artery disease (CAD), PAU was no longer significantly predictive of the above combined endpoint (p = 0.268).

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