Correlation between Percentage of Reticulated Platelets and Heart Score in Patients with Suspected Non-ST Elevation Acute Coronary Syndromes

Fransisca Mulyadi, Delita Prihatni, Coriejati Rita, Dewi Kartika Turbawaty, Astri Astuti


Thrombus formation in non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) causes increased platelet
consumption, leading to a 20-fold increase of Reticulated Platelets (RP) release. Reticulated platelets have more granules
and proteins that make them quickly forming thrombus than mature platelets, potent to form bigger thrombus, and
increase the risk of Major Adverse Cardiac Events (MACE). HEART score is a risk stratification for possible NSTE-ACS, which
can predict MACE. The study aimed to analyze the correlation between the percentage of reticulated platelets and HEART
score. This research was a correlation observational cross-sectional study performed in Dr. Hasan Sadikin Hospital,
Bandung, from August 2018 to May 2019. The subjects were patients suspected with NSTE-ACS by clinicians in the
Emergency Department of Dr. Hasan Sadikin Hospital. These subjects were assessed for the HEART score and
RP percentage. This study involved 52 subjects consisting of a higher number of males (76.9%) aged 45-64 years old (69.2%).
HEART score stratification in this study was mostly high risk (69.2%), but none was low risk. Mean of platelet count, absolute
3 3 RP, and RP percentage were 271±73 x103/mm , 9.3±4.3 x 103/mm , and 3.6±1.7%, respectively. The correlation test
between RP percentage and HEART score with a 95% confidence interval using Spearman's correlation test showed a
significant positive correlation with moderate strength (p < 0.001 and r=0.475). The percentage of RP in this study was in the
normal range. However, there was a significant positive correlation with moderate strength between the percentage of RP
and HEART scores in patients with suspected non-ST elevation acute coronary syndrome.


HEART score, non-ST elevation acute coronary syndrome, percentage of reticulated platelets

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Roffi M, Patrono C, Collet JP. 2015 ESC guidelines for

the management of acute coronary syndromes in

patients presenting without persistent ST-segment

elevation. Eur Heart J, 2016; 37(1): 267-315.

Giugliano RP, Braunwald E. Non-ST elevation acute

coronary syndromes. In: Zipes DP, Libby P, Bonow RO,

editor. Braunwald's heart disease, a textbook of

th cardiovascular medicine. 11 Ed., Philadelphia,

Elsevier, 2019; 1181-208.

Hedayati T, Yadav N, Khanagavi J. Non-ST Segment

acute coronary syndromes. Cardiol Clin, 2018; 36: 37-52.

Eisen E, Giugliano RP, Braunwald E. Updates on acute

coronary syndrome: A review. JAMA Cardiology, 2016;

(6): 1-13.

Timmis A. Acute coronary syndromes. BMJ, 2015; 351:


Sanchis-Gomar F, Perez-Quiliz C, Leischik R.

Epidemiology of coronary heart disease and acute

coronary syndrome. Ann Transl Med, 2016; 4(3): 256-23.

Mass AH, Appelman YE. Gender differences in

coronary heart disease. Netherlands Heart Journal,

; 18(12): 598-603.

Mirza AJ, Taha AY, Khdhir BR. Risk Factors for acute

coronary syndrome in patients below the age 40 years.

Egypt Heart J, 2018; 70: 233-5.

Libby P, Ridker PM, Croce K. Pathophysiology of

atherothrombosis. In: Marder VJ, Aird WC, Bennett JS,

editor. Hemostasis and thrombosis, basic principles,

and clinical practice. Philadelphia, Lippincott Williams

& Wilkins, 2013; 1047-58.

Apple FS, Goetze JP, Jaffe AS. Cardiovascular disease.

In: Burtis CA, Bruns DE, editor. Tietz fundamentals of

th clinical chemistry and molecular diagnostics. 7 Ed.,

Missouri, Elsevier, 2015; 632-49.

Abbate R, Cioni G, Ricci I. Thrombosis, and acute

coronary syndrome. Thrombosis Research, 2012; 129:


Bentzon JF, Otsuka F, Virmani R. Mechanisms of

plaque formation and rupture. Circ Res, 2014; 114:


Backus BE, Six AJ, Kelder JH. Risk scores for patients

with chest pain: Evaluation in the Emergency

Department. Curr Cardiol Rev, 2011; 7(1): 2-8.

Byrne C, Toarta C, Backus B. The HEART score in predicting major adverse cardiac events in patients

presenting to the Emergency Department with

possible acute coronary syndrome: Protocol for a

systematic review and meta-analysis. Systematic

Reviews, 2018; 7(1): 1-11.

Brady W, Souza Kd. The HEART score: A guide to its

application in the Emergency Department. Turk J

Emerg Med, 2018; 18(1): 47-51.

Backus BE, Six AJ, Kelder JC. A Prospective validation of

the HEART score for chest pain patients at the

Emergency Department. Int J Cardiol, 2013; 168(1):


Grove EL, Kristensen SD, Hvas A-M. Immature platelets

in patients with acute coronary syndromes. Thromb

Haemost, 2009; 101: 151-56.

Cesari F, Marcucci R, Gori AM. Reticulated platelets

predict cardiovascular death in acute coronary

syndrome patients. Thromb Haemost, 2013; 109(5): 1-8.

Khalifa KA, Helwa MA, Mohammed AM. Reticulated

platelets in acute coronary syndrome patients.

Menoufia Med J, 2016; 30: 880-86.

Ko YJ, Hur M, Kim H. Reference interval for immature

platelet fraction on Sysmex XN hematology analyzer:

A comparison study with Sysmex XE-2100. Clin Chem

Lab Med, 2014; 1-7.

Hoffmann JJ. Reticulated platelets: Analytical aspects

and clinical utility. Clin Chem Lab Med, 2014; 52(8):


McBane RD, Gonzalez C, Hodge DO. Propensity for

young reticulated platelet recruitment into arterial

thrombi. J Thromb Thrombolysis, 2013; 1: 1-7.

Ibrahim H, Schutt RC, Hannawi B. Association of

Immature platelets with adverse cardiovascularoutcomes. JACC, 2014; 64(20): 2122-29.

Worrall-Carter L, McEvedy S, Wilson A. Gender

differences in presentation, coronary intervention, and

outcomes of acute coronary syndrome patients in

Victoria, Australia. Women's Health Issues, 2016; 26(1):


Picariello C, Lazzeri C, Attana P. The impact of

hypertension on patients with acute coronary

syndromes. Int J Hypertens, 2011; 1: 1-7.

Barua RS, Ambrose JA. Mechanisms of coronary

thrombosis in cigarette smoke exposure. Arterioscler

Thromb Vasc Biol, 2013; 33: 1460-7.

PERKI. Sindrom koroner akut. Pedoman tata laksana

sindrom koroner akut. Ed ke-4., 2018; 1-15.

Cannon CP, Braunwald E. Non-ST-segment elevation

acute coronary syndrome (Non-ST-segment elevation

myocardial infarction and unstable angina). In:

Loscalzo J, editor. Harrison's Cardiovascular Medicine.

rd 3 Ed., New York, McGraw-Hill, 2017; 461-68.

Jabbar AA, Ahsan C. Troponin I, and the likelihood of

hemodynamically significant coronary artery disease in

patients with NSTE-ACS. Int J Cardiol, 2013; 170: 17-9.

Nishimura S, Nagasaki M, Kunishima S. IL-1a induces

thrombopoiesis through megakaryocyte rupture in

response to acute platelet needs. J Cell Biol, 2015;

(3): 453-66.

Nieswandt B, Stritt S. Megakaryocyte rupture for acute

platelet needs. J Cell Biol, 2015; 209(3): 27-8.

Arend WP. The balance between IL-1 and IL-1Ra in

disease. Cytokine and Growth Factor Rev, 2002; 13:


Gonzalez-Porras JR, Martin-Herrero F, Gonzalez-Lopez

TJ. The role of immature platelet fraction in acute

coronary syndrome. Thromb Haemost, 2010; 103(1):




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