Platelet aggregation, coronary artery disease progression and future coronary events

Am J Cardiol. 1994 Feb 15;73(5):333-8. doi: 10.1016/0002-9149(94)90004-3.


The platelet-aggregatory response, platelet-release factors and markers of thrombin generation in vivo were studied prospectively in 53 patients participating in a randomized clinical trial evaluating the influence of nicardipine on the progression of coronary atherosclerosis. Coronary lesions were measured quantitatively and progression was defined as a decrease in minimum diameter by > or = 0.4 mm. At repeat angiography 24 months after study entry, 20 of the 53 patients had progression of 28 coronary narrowings. Only thrombin-induced enhanced platelet aggregation differentiated patients with from those without coronary disease progression, with an estimated odds ratio of 2.49 (95% confidence interval 1.10 to 5.66). The aggregatory response to adenosine diphosphate, collagen, epinephrine and platelet-activating factor were not different in the 2 groups of patients, nor were measurements of platelet factor 4, beta-thromboglobulin, thromboxane B2, 6-keto-prostaglandin F1 alpha and fibrinopeptide A. During 46.8 months of follow-up after repeat angiography, coronary events occurred in 11 of the 20 with and 6 of the 33 without progression (difference 37%, p = 0.013, confidence interval 11 to 63%). Those with coronary disease progression and an enhanced thrombin-induced platelet aggregation had a worse prognosis than those with no disease progression and a low thrombin-induced platelet aggregation. Thus, patients with coronary disease progression and future coronary events have an enhanced thrombin-induced platelet aggregation. This platelet abnormality may be a marker of increased risk and may play a causative role in the development of coronary events.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 6-Ketoprostaglandin F1 alpha / blood
  • Coronary Angiography
  • Coronary Disease / blood*
  • Coronary Disease / physiopathology*
  • Coronary Disease / prevention & control
  • Double-Blind Method
  • Female
  • Fibrinopeptide A / analysis
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nicardipine / therapeutic use
  • Placebos
  • Platelet Aggregation / drug effects
  • Platelet Aggregation / physiology*
  • Platelet Factor 4 / analysis
  • Prospective Studies
  • Survival Rate
  • Thrombin / pharmacology
  • Thromboxane B2 / blood
  • beta-Thromboglobulin / analysis


  • Placebos
  • beta-Thromboglobulin
  • Fibrinopeptide A
  • Platelet Factor 4
  • Thromboxane B2
  • 6-Ketoprostaglandin F1 alpha
  • Nicardipine
  • Thrombin