Blood cell aggregation as a hemorheological marker of long-term clinical outcome after percutaneous coronary intervention in patients with coronary artery disease

Background We evaluated serial blood cell aggregation changes after PCI in CAD patients and their 12-month outcomes. Methods We prospectively enrolled 120 elective PCI CAD patients and 50 frequency-matched controls. Blood was collected pre-PCI, on Days 3, 8, and Month 3. Erythrocyte aggregation index (EAI) was assessed by TAS-plus aggregometry. Patients were grouped into Group I (favorable, n = 106) and Group II (repeat PCI, n = 14). Results CAD patients showed higher baseline EAI (0.43 ± 0.06vs.0.29 ± 0.04, p < 0.001), fibrinogen (4.1 ± 0.6vs.2.9 ± 0.4 g/L, p < 0.001), and leukocyte aggregation (32.4 ± 5.8%vs.21.4 ± 4.2%, p < 0.001) than controls. Linear mixed-effects modeling revealed a significant group-by-time interaction for EAI (F(3, 354) = 5.12, p = 0.002). Over 3 months, Group I showed progressive EAI normalization (0.42 ± 0.05 to 0.31 ± 0.03, p < 0.001), whereas Group II maintained elevated EAI (0.46 ± 0.07 to 0.44 ± 0.06, p = 0.245). Leukocyte aggregation increased transiently at Day 3 in both CAD groups (39.8 ± 6.7%vs.40.1 ± 6.5%) and returned to baseline by Month 3 (31.8 ± 5.4% vs. 32.1 ± 5.5%, p = 0.842), showing no persistent between-group differences in this cohort. ADP-induced platelet aggregation was significantly suppressed post-PCI at Day 3 (50.2 ± 7.6%vs.50.7 ± 7.4%, p < 0.001) without between-group differences. Conclusions Persistent erythrocyte hyperaggregation post-PCI is associated with recurrent ischemia and repeat revascularization and may represent a potential biomarker for clinical risk stratification, pending validation in larger, multicenter prospective studies.