Glycoprotein VI as a prognostic biomarker for cardiovascular death in patients with symptomatic coronary artery disease.

Background: Platelets play a critical role in arterial thrombosis, acute coronary syndrome (ACS) and stroke. Platelet collagen receptor glycoprotein VI (GPVI) is associated with acute coronary events and a poor clinical outcome.

Methods: Between January 2006 and March 2009, we evaluated 2,213 consecutive patients in a prospective study design, who presented with chest pain. Among 1,819 patients (82.2%) who underwent coronary angiography, 1,652 patients (90.8%) showed a coronary and 167 patients (9.2%) a non-coronary origin of chest pain. 901 patients (54.5%) presented with an ACS, 751 (45.5%) with a stable angina pectoris. Clinical outcome was performed by a predefined structured telephone interview after a 3-month follow-up (92.8%:1,533 of 1,652 patients).

Results: Kaplan-Meier analysis for cumulative event-free survival revealed that patients with a elevated baseline GPVI expression had a poorer clinical outcome for cardiovascular death than patients with decreased GPVI levels (log rank; P = 0.040). These results were paralleled in composite cumulative survival that included myocardial infarction, stroke, and cardiovascular death (log rank; P = 0.002). Relative risk of cardiovascular death was found at 1.41 (95% CI 1.08-1.85) for platelet GPVI, 1.64 (95% CI 1.31-2.05) for brain natriuretic peptide, 1.16 (95% CI 0.81-1.64) for troponin-I and 1.33 (95% CI 0.97-1.82) for C-reactive protein.

Conclusions: Patients with CAD presenting increased levels of platelet GPVI had a poorer outcome and may profit from a dual antiplatelet therapy. Thus, GPVI may be a useful prognostic tool for adverse cardiovascular events. Future studies should substantiate GPVI for its potential role of risk prediction and consider its prognostic value to improve risk stratification.