Usefulness of Mean Platelet Volume to Predict Significant Coronary Artery Disease in Patients With Non–ST-Elevation Acute Coronary Syndromes

doi:10.1016/j.amjcard.2016.09.042

The American Journal of Cardiology

Volume 119, Issue 2, 15 January 2017, Pages 192-196

https://doi.org/10.1016/j.amjcard.2016.09.042 Get rights and content

Acute coronary syndrome (ACS) is characterized by unstable plaque with thrombotic process involving central role of platelets. The diagnosis and prediction of significant coronary artery disease (CAD) in non–ST-elevation ACS (NSTE-ACS) can be challenging. The central role of platelets in acute atherothrombosis in NSTE-ACS spurred appreciable interest in the diagnostic and predictive role of platelet activity. Mean platelet volume (MPV) is one of the most promising laboratory markers in patients with CAD. This retrospective study was designed to investigate the diagnostic and predictive value of high MPV levels in patients with NSTE-ACS with significant CAD. A total of 213 patients (men 53%, mean age 61 ± 12.3 years) with NSTE-ACS were enrolled from 2011 to 2016 from 2 teaching hospitals. Patients' demographic, laboratory, and angiographic data were collected. Significant CAD was defined as ≥70% stenosis in at least 1 major coronary artery. Patients with high MPV (MPV ≥9 fl) had more significant CAD (55% vs 35%, p = 0.005), lower platelet count (204 ± 59 × 1,000/μl vs 246 ± 56 × 1,000/μl, p = 0.001), and higher HbA1c (6.9 vs 6.4, p = 0.02). Patients with significant CAD had higher MPV level (9.2 ± 1.07 vs 8.6 ± 1.03 fl, p = 0.001), higher MPV/platelet ratio (0.46 vs 0.40, p = 0.01), older age (64.5 ± 11 vs 59.2 ± 12 years, p = 0.02), and lower high-density lipoprotein level (42 ± 12 vs 47 ± 16, p = 0.01). Multivariate analysis showed that increased age, high MPV, high troponin, and low high-density lipoprotein levels were associated with significant CAD. Patients with high MPV along with high troponin level demonstrated a 4.8-fold increased risk for significant CAD compared to those with normal MPV and high troponin (odds ratio 4.8, 95% confidence interval 1.31 to 17.6, p = 0.001). In conclusion, considering high MPV in the context of elevated troponin level increases the predictive value of screening for significant CAD, and this result may help determine who is most likely to benefit from cardiac catheterization.

Section snippets

Method

This retrospective study enrolled 213 patients with NSTE-ACS from 2 teaching hospitals (Presence St. Francis Hospital, Illinois, and Presence St. Joseph Hospital, Illinois) who had undergone conventional coronary angiography from January 2011 to February 2016. Patients' demographic, laboratory, and angiographic data were collected. Significant CAD was defined as ≥70% stenosis in at least 1 major coronary artery or major side branch.5, 6 All patients underwent coronary angiogram within 24 hours

Results

A total of 213 patients were enrolled (mean age 61 ± 12.3 years, men 53.3%). The mean MPV level was 8.9 fl (Table 1). Study cohort was classified into 2 groups: high MPV group (MPV ≥9 fl) and normal MPV group (MPV <9 fl). The high MPV group had more significant CAD, lower platelet count, and higher glycohemoglobin levels (Table 1). Both groups had similar major cardiac risk factors of diabetes mellitus hypertension and hyperlipidemia, smoking, obesity, and aspirin use (Table 1). Binary logistic

Discussion

NSTE-ACS remains a major cause of hospital admission, morbidity, and mortality. Noncardiac causes of troponin elevation, electrocardiographic changes, and chest pain remain the main diagnostic and predictive challenge of underlying significant CAD. There is no ideal single diagnostic test, to predict underlying significant CAD. Therefore, there are several cardiac risk stratification approach and ongoing studies to identify patients who would most benefit from invasive cardiac studies.1, 3 High

Disclosures

The authors have no conflicts of interest to disclose.

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Cell counting in peripheral blood samples and their combinations have gained wide usage in clinical research due to their convenient and minimally invasive sampling method. This study aims to evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR), systemic Immunoinflammatory Index (SII), and systemic Inflammatory Response Index (SIRI), and platelet distribution width (PDW) for the occurrence of non-arteritic Central retinal artery occlusion (NA-CRAO).
We included 123 patients diagnosed with NA-CRAO and 120 age-, sex- and blood pressure-matched individuals in this study. All participants underwent a comprehensive ophthalmic assessment. Peripheral blood samples were retrospectively analysed to obtain patients' blood counts and platelet-related indices, and further NLR, SII and SIRI were calculated.
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Clinical utility of mean platelet volume and immature platelet fraction in acute coronary syndrome
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Citation Excerpt :
In the future, to combine ECG with MPV, IPF and troponin-I to evaluate ACS accuracy deserves further investigation. Studies on the predictive value of MPV or IPF for the prognosis of ACS patients are still contradictory [46,47]. We observed an increased mortality rate in ACS patients with high IPF (11.1%), compared to patients with high MPV (5.4%) or patients with increased initial TnI (8.1%).
Platelets play an important role in the pathogenesis of acute coronary syndrome (ACS). Patients with ACS have an increased mean platelet volume (MPV) and immature platelet fraction (IPF) resulting in elevation of thrombotic ability. In this study, we evaluated the diagnostic performance of MPV and IPF in identifying suspected ACS patients at emergency department. Moreover, we investigated the correlation between MPV or IPF with initial troponin I (TnI), one of the current ACS biomarkers.
This was a single-center study recruiting suspected ACS patients who had acute chest pain at the emergency department. Whole blood samples were obtained from all participants and MPV and IPF were measured by Sysmex XE-5000 hematology analyzer within 20 min of blood sampling. The diagnostic values of MPV and IPF in identifying ACS were analyzed retrospectively.
In this study, 63 in 104 suspected ACS patients were diagnosed as ACS (65.3%). MPV and IPF were higher in ACS patients compared to non-ACS patients (MPV: 10.7 ± 0.80 fL vs 10.0 ± 0.64 fL, p < 0.001; IPF: 3.7 ± 2.64% vs 3.1 ± 2.69%, p = 0.030). MPV and IPF were similar in unstable angina and acute myocardial infarction patients. We showed that elevation of MPV could be an independent predictive factor of ACS (odds ratio: 5.038). At the optimal cut-off value of 10.55 fL (AUC 95% CI: 0.637–0.836), the diagnostic performance of MPV in predicting ACS had an area under a receiver operating characteristic curve (AUC) of 0.736 with sensitivity and specificity of 54.2% and 82.8%, respectively. Patients with both of initial TnI and MPV higher than the established cut-off value had increased incidence (3.792 fold) for ACS development compared to patients with TnI below the cut-off value. Furthermore, diagnosing ACS with both MPV and initial TnI increased the positive predictive value from 84.2% to 86.7%. No correlation was observed between MPV or IPF and the mortality rate of ACS patients (MPV: 3.8% vs 11.1%, p = 0.300; IPF: 12.0% vs 37.5%, p = 0.054).
Here we show that ACS patients have higher MPV and IPF compared to non-ACS patients. We further demonstrate that MPV can be utilized as an independent predictor for early diagnosis of low-risk ACS patients who have acute chest pain.
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MPV level was also reported to be higher in acute MI patients than in patients with stable CAD [4]. Interestingly, the median MPV level in our study tended to be higher than that in previous studies that included ACS patients [8,20]. High MPV levels have been associated with poor clinical outcomes in ACS patients.
Although an elevated mean platelet volume (MPV) has been associated with poor clinical outcomes after acute coronary syndrome (ACS), the association between MPV and long-term outcomes in patients with stable coronary artery disease (CAD) remains uncertain. We aimed to investigate the impact of pre-procedural MPV levels in patients following elective percutaneous coronary intervention (PCI).
We studied 2872 stable CAD patients who underwent their first PCI and who had available data on pre-procedural MPV between 2002 and 2016. Patients were divided into quartiles based on their MPV. The incidences of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, were evaluated.
The median MPV was 10.4 fL (interquartile range: 9.8–11.0). During a median follow-up of 5.6 years, 498 (17.3%) MACE were identified, with a cumulative incidence significantly higher in the lowest MPV group than in other groups (p < 0.01). After adjustment for platelet count and the other cardiovascular risk factors, the lowest MPV group had a significantly higher risk of MACE compared with the highest MPV groups (hazard ratio: 1.43, 95% confidence interval 1.10–1.86, p = 0.009). Decreasing MPV as a continuous variable was associated with the incidence of MACE (hazard ratio: 1.16 per 1 fL decrease, 95% confidence interval 1.04–1.30, p = 0.007).
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Coronary Artery DiseaseUsefulness of Mean Platelet Volume to Predict Significant Coronary Artery Disease in Patients With Non–ST-Elevation Acute Coronary Syndromes

Section snippets

Method

Results

Discussion

Disclosures

Am J Cardiol

J Am Coll Cardiol

J Thromb Haemost

J Am Coll Cardiol

J Am Coll Cardiol

Atherosclerosis

Thromb Res

Thromb Res

The 2012 ACCF/AHA focused update of the Unstable Angina/Non-ST-Elevation Myocardial Infarction (UA/NSTEMI) Guideline: a critical appraisal

Methodist Debakey Cardiovasc J

Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials

JAMA

A role for changes in platelet production in the cause of acute coronary syndromes

Arterioscler Thromb Vasc Biol

Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS)

J Clin Invest

Coronary angiographic scoring systems: an evaluation of their equivalence and validity

Am Heart J

Rev Esp Cardiol

Coronary Artery Disease
Usefulness of Mean Platelet Volume to Predict Significant Coronary Artery Disease in Patients With Non–ST-Elevation Acute Coronary Syndromes