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Thromb Haemost 2024; 124(04): 310-319
DOI: 10.1055/s-0043-1773763
Cellular Haemostasis and Platelets

Reticulated Platelets Predict Cardiovascular Death and Adverse Events in Coronary Artery Disease: A Systematic Review and Meta-analysis

Dario Bongiovanni 
1   Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
2   Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
3   Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
,
Laura Novelli 
2   Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
,
Francesco Condello 
2   Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
,
Kilian Kirmes
3   Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
,
Jiaying Han
3   Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
,
Bastian Wein
1   Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
,
Sébastien Elvinger
1   Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
,
Giacomo Viggiani
3   Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
,
Moritz von Scheidt
4   Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
,
Karl-Ludwig Laugwitz
3   Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
5   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
,
Philip W.J. Raake
1   Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
,
Adnan Kastrati 
4   Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
5   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
,
Mauro Chiarito‡   *
2   Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
,
Isabell Bernlochner‡   *
3   Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
5   German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
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Comment on:

Reticulated Platelets: A Promising Prognosis Marker in Cardiovascular DiseasesThromb Haemost 2024; 124(04): 320-323
DOI: 10.1055/a-2170-1892

Abstract

Background The pro-thrombotic immature or reticulated platelets (RPs) are known to be elevated in high-risk patients and in different pathological settings. It has been shown that RPs correlate with an insufficient antiplatelet response to antiplatelet agents. RPs are emerging novel predictors of adverse cardiovascular events in cardiovascular disease. This study, using the totality of existing evidence, evaluated the prognostic role of RPs in patients with coronary artery disease.

Methods We performed a systematic review and meta-analysis including trials of acute and chronic coronary syndrome reporting clinical outcomes according to RPs levels in the peripheral blood. We compared patients with elevated RPs (RPshigh) to patients without elevated RPs (RPslow). Odds ratios (ORs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints were cardiovascular death, myocardial infarction, ischemic stroke, urgent coronary revascularization and bleedings.

Results A total of 7 studies, including 2213 patients, were included. The risk for MACCE was significantly higher in RPshigh compared to RPslow patients (OR 2.67 [1.87; 3.81], I2  = 43.8%). RPshigh were associated with cardiovascular death (OR 2.09 [1.36; 3.22], I2  = 40.4%). No associations for RPshigh were detected with the other singular components of MACCE: myocardial infarction (OR 1.73 [0.89; 3.38] I2  = 60.5%) and stroke (OR 1.72 [0.59; 4.96] I2  = 21%). The risk of bleeding did not differ between groups(OR 0.58 [0.15; 2.22] I2  = 86.1%).

Conclusion Elevated RPs are significantly associated with increased risk of cardiovascular events and cardiovascular death.

Key Words

ACS - immature platelets - immature platelet fraction - IPF - reticulated platelets - CCS - biomarker

* These authors contributed equally to this study.


Supplementary Material



Publication History

Received: 21 April 2023

Accepted: 31 July 2023

Article published online:
11 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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