Association between aspirin resistance and indices of inflammation and platelet activity in patients with acute coronary syndrome

Purpose: Aspirin resistance (AR) has been linked to increased cardiovascular morbidity and mortality in patients with acute coronary syndrome (ACS). Both ACS and AR have also been associated with enhanced platelet activity and inflammatory responses. This study aimed to evaluate the power of the levels of uric acid (UA), non-high-density lipoprotein (non-HDL) cholesterol, high-sensitivity C-reactive protein (Hs-CRP), and gamma-glutamyltransferase (GGT) and the mean platelet volume (MPV), to predict AR in patients with ACS. Materials and Methods: This study included543 patients with ACS. AR was identified by whole blood aggregometry. Predictors of AR were determined through multivariate regression analyses and the receiver operating characteristic (ROC) curve analysis. Results: The levels of UA, GGT, non-HDL cholesterol, MPV, and Hs-CRP were significantly higher in patients with AR compared to those without AR (5.6±1.5 vs.6.8±3.1, 20 vs 34 (median), 162.3±43.2 vs. 143.2±37.1, 8.2 ±0.9 vs. 8.9 ±1.1, 5.0 vs 14.7 (median)). A multivariate regression analysis identified MPV, UA, Hs-CRP and presence of clopidogrel resistance as independent predictors of AR. Conclusion: In patients with ACS, AR was found to be associated with elevated platelet activity and inflammation, suggesting that these factors might contribute to the development of AR or might be underlying mechanisms of AR. These findings highlight potential benefit of a routine workup to assess the oxidative status, inflammation, and thrombogenicity that may help risk stratification and treatment decision-making in clinical Practice, in patients with AR.