Aspirin resistance in acute coronary syndromes and temporal variability of platelet reactivity and short term impact on prognosis

Coronary heart disease is the most common cause of death in the world. ACS is most commonly encountered form of coronary heart disease in clinics. NSTEMI, USAP and STEMI are different manifestations of ACS. NSTEMI and USAP are together called as NSTE - ACS. Acute coronary syndromes are public health problems in which the prevalence is significantly increasing in the world and in our country. Risk factors including age and gender that can not be changed and editable risk factors as DM, HT, smoking, HPL plays role in the development of acute coronary syndromes. In this study, aspirin resistance in ACS and it's relationship between MPV which is an indirect indicator of platelet reactivity and their effect on short-term outcomes were evaluated. Between June 2013 - September 2014, 115 patients who fulfilled inclusion criterias admitted to Akdeniz University Faculty of Medicine, Emergency Service and hospitalized in Cardiology Clinic with a diagnosis of ACS, available according to the study were enrolled. Acute coronary syndrome types on admission, risk factors, medical history, aspirin resistance and MPV values were examined. Aspirin resistance and MPV values at 1st month were compared to the baseline admission values. Aspirin resistance was assessed by multiplate impedance aggregometry. In our study, patients were followed up from admission to their controls at 1 month. Most of the patients were male (83.4%). The majority of patients admitted (55.6%) admitted with STEMI and when evaluated according to the most frequent localization, inferior MI was observed (32.1%) most. In our study, on admission and at the 1. month aspirin resistance indexes were respectively 175.9175.2 AU and 297.1250.5 AU. Aspirin resistance increase defined by AU values at 1st month was statistically significant (p:0.0001). Mean MPV values on admission and at the 1st month were respectively 8.500.77 fl and 8.490.78 fl. Observed 0.01 fl increase in mean thrombosis volume was not statistically significant (p:1.0). Aspirin resistance was significantly higher in female patients and smokers. (p:0.0001 and p:0.007). Major or minor bleeding were not observed during the study period. Four adverse clinical events were observed. One patient died due to early stent thrombosis and CVE. One patient was hospitalized due to decompensate HF. Acute coronary syndrome was developed in two patients. Balloon angioplasty was performed inside stent for one of the patients and another patient were referred for surgery due to aneurysm developed in stent. Even in the short term 1-month follow-up of patients temporal variability was found in the aspirin resistance which may be considered clinically significant. We concluded that, the data and the results obtained in this study, should be supported by prospective studies with larger patient populations