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CME Evaluation

Oral Communication Session

Vascular Biology, Blood Cells, and Immunothrombosis

Session: Circulating factors in thromboinflammation

OC 79.5 - Platelet-associated Tissue Factor predicts 5-year mortality in Coronary Artery Disease patients

Wednesday, June 26, 2024
11:15 – 11:30 ICT
Room: 209 A-D
Background: Improvement of thrombotic risk stratification in coronary artery disease (CAD) patients is an unmet need. Biomarkers of platelet (PLT) activation are not considered in CAD risk scores. Among the PLT activation markers, Tissue Factor (TF), along with phosphatidylserine, drives platelet-prothrombotic properties and its increased levels have been reported in several diseases including CAD.

Aims: To assess the prognostic value of PLT-associated activation biomarkers on mortality in CAD patients.

Methods: Surface platelet expression of P-selectin, activated GPIIbIIIa and TF and monocyte-TF expression, were evaluated in 527 CAD patients. Prognostic outcomes were all-cause and cardiovascular (CV) mortality. 5-years survival analysis was performed with Cox regression model. Euclidean distance method was used to calculate the best cut-off value of PLT-associated TF expression. Kaplan-Meier survival analysis was performed.

Results: All-cause mortality and CV mortality rates were 9.7% and 6.4%, respectively. COX regression analyses indicated that only PLT-associated TF was an independent predictor of all-cause (HR=2.02; p=0.042) and CV mortality (HR=2.33, p=0.0278). A cut-off value for primary endpoint prediction of 4% TFpos-PLT, calculated by ROC curve, was confirmed with a cross-validation analysis. All-cause and CV mortality incidence in patients with a score above and below the cut-off was 30.6 and 16.1 (p=0.0192) and 23.3 and 9.3 (p=0.0058) per 1000 person-years, respectively. Kaplan-Meier survival analysis showed that patients with levels of TFpos-PLT>4% had a worse prognosis compared to those with < 4% TFpos-PLT. Analysis restricted to patients on dual-antiplatelet-therapy according to therapeutic response to P2Y12 antagonists showed that good responders with TFpos-PLT >4% were those with increased risk for all-cause mortality (HR: 4.11; p= 0.0215) and CV mortality (HR: 6.88; p= 0.0408).

Conclusion(s): Our findings highlight that PLT-TF can implement the thrombotic risk stratification being an independent predictor of all-cause and CV disease mortality in CAD patients on antiplatelet therapy.