Could Higher Platelet Indices on Admission Predict Re-Infarction & Adverse Outcomes in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention (PPCI)? A Single-Center Experience
Objectives: Platelet indices, such as platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit (PCT), can provide insights into platelet activation. Large platelets are more active and have higher thrombotic potential than small platelets, suggesting that larger platelets play a role in ST-elevation myocardial infarction (STEMI). To assess PDW, MPV, and PCT and their relation to severity and validity for prediction of primary, secondary outcomes, and MACE in acute STEMI patients who underwent PPCI.
Methods: This prospective study included 115 consecutive STEMI patients who underwent PPCI. Admission blood samples were measured for MPV, PDW, and PCT. The SYNTAX and Gensini (GS) scores were used to quantify the severity of CAD. Patients were followed up for a period of 3 to 6 months with regard to primary and secondary clinical outcomes.
Results: PDW had a moderate positive correlation with SYNTAX score (r=0.321, p<0.001) and GS (r=0.270, p=0.002), and a negative correlation with TIMI Risk (r=-0.199, p=0.017) and ejection fraction (r=-0.170, p=0.034). Also, MPV had a significant positive correlation with SYNTAX score (r=0.235, p=0.006). PDW had the highest diagnostic accuracy for the prediction of the primary outcome and MACE.
Conclusion: PDW, a low-cost and easily measured laboratory test, could be used as a predictor of re-infarction and adverse outcomes in STEMI patients.
1. Martin JF, Kristensen SD, Mathur A, Grove EL, Choudry FA. The causal role of megakaryocyte–platelet hyperactivity in acute coronary syndromes. Nat Rev Cardiol 2012;9:658–70.
2. Karpatkin S. Biochemical and clinical aspects of megathrombocytes. Ann N Y Acad Sci 1972;201:262–79. 3. Indriastuti E, Hernaningsih Y, Indrasari YN. Immature platelet fraction as a potential marker to differentiate types of acute coronary syndrome. Indones J Med Lab Technol 2020;27:16–21.
4. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, et al. Mean platelet volume as a predictor of cardiovascular risk: A systematic review and meta-analysis. J Thromb Haemost 2010;8:148–56.
5. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: A link between thrombosis and inflammation? Curr Pharm Des 2011;17:47–58.
6. Budzianowski J, Pieszko K, Burchardt P, Rzeźniczak J, Hiczkiewicz J. The role of hematological ındices in patients with acute coronary syndrome. Dis Markers 2017;2017:3041565.
7. De Luca G, Venegoni L, Iorio S, Secco GG, Cassetti E, Verdoia M, et al; Novara Atherosclerosis Study Group. Platelet distribution width and the extent of coronary artery disease: Results from a large prospective study. Platelets 2010;21:508–14.
8. Sansanayudh N, Anothaisintawee T, Muntham D, McEvoy M, Attia J, Thakkinstian A. Mean platelet volume and coronary artery disease: A systematic review and meta-analysis. Int J Cardiol 2014;175:433–40.
9. Khandekar MM, Khurana AS, Deshmukh SD, Kakrani AL, Katdare AD, Inamdar AK. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: An Indian scenario. J Clin Pathol 2006;59:146–9.
10. Seyyed-Mohammadzad MH, Eskandari R, Rezaei Y, Khademvatani K, Mehrpooya M, Rostamzadeh A, et al. Prognostic value of mean platelet volume in patients undergoing elective percutaneous coronary intervention. Anatol J Cardiol 2015;15:25–30.
11. Choi DH, Kang SH, Song H. Mean platelet volume: A potential biomarker of the risk and prognosis of heart disease. Korean J
Intern Med 2016;31:1009–17.
12. Bekler A, Ozkan MT, Tenekecioglu E, Gazi E, Yener AU, Temiz A, et al. Increased platelet distribution width ıs associated with severity of coronary artery disease in patients with acute coronary syndrome. Angiology 2015;66:638–43.
13. Rechciński T, Jasińska A, Foryś J, Krzemińska-Pakuła M, Wierzbowska-Drabik K, Plewka M, et al. Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention. Cardiol J 2013;20:491–8.
14. Cetin MS, Ozcan Cetin EH, Akdi A, Aras D, Topaloglu S, Temizhan A, et al. Platelet distribution width and plateletcrit: Novel biomarkers of ST elevation myocardial infarction in young patients. Kardiol Pol 2017;75:1005–12.
15. Killip T 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967;20:457–64.
16. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction; Katus HA, Lindahl B, Morrow DA, Clemmensen PM, Johanson P, Hod H, et al. Third universal definition of myocardial infarction. Circulation 2012;126:2020–35.
17. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021;42:1289–367.
18. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119–77.
19. Hartley A, Marshall DC, Salciccioli JD, Sikkel MB, Maruthappu M, Shalhoub J. Trends in mortality from ıschemic heart disease and cerebrovascular disease in Europe: 1980 to 2009. Circulation 2016;133:1916–26.
20. Sugiyama T, Hasegawa K, Kobayashi Y, Takahashi O, Fukui T, Tsugawa Y. Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States, 2001- 2011. J Am Heart Assoc 2015;4:e001445.
21. Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000;102:2031–7.
22. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al; American College of Cardiology; American Heart Association. Committee on the Management of Patients With Unstable Angina. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--summary article: A report of the American College of Cardiology/ American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol 2002;40:1366–74.
23. Karpatkin S. Heterogeneity of human platelets. VI. Correlation of platelet function with platelet volume. Blood 1978;51:307–16.
24. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: A simple, practical and specific marker of activation of coagulation. Hippokratia 2010;14:28–32.
25. Uğur M, Ayhan E, Bozbay M, Çiçek G, Ergelen M, Işık T, et al. The independent assocıatıon of plateletcrıt wıth long-term outcomes in patıents undergoıng prımary percutaneous coronary interventıon. J Crit Care 2014;29:978–81.
26. Akpinar I, Sayin MR, Gursoy YC, Aktop Z, Karabag T, Kucuk E, et al. Plateletcrit and red cell distribution width are independent predictors of the slow coronary flow phenomenon. J Cardiol 2014;63:112–8.
27. Niu X, Liu G, Huo L, Zhang J, Bai M, Peng Y, et al. Risk stratification based on components of the complete blood count in patients with acute coronary syndrome: A classification and regression tree analysis. Sci Rep 2018;8:2838.
28. Reaney PDW, Elliott HI, Noman A, Cooper JG. Risk stratifying chest pain patients in the emergency department using HEART, GRACE and TIMI scores, with a single contemporary troponin result, to predict major adverse cardiac events. Emerg Med J 2018;35:420–7.
29. Kiliçli-Camur N, Demirtunç R, Konuralp C, Eskiser A, Başaran Y. Could mean platelet volume be a predictive marker for acute myocardial infarction? Med Sci Monit 2005;11:CR387–92.
30. Bharihoke N, Subhedar V, Singh P, Gupta P. Mean platelet volume and other platelet volume indices in Acute Myocardial Infarction (AMI) and Stable Coronary Artery Diseases (SCAD): A hospital based prospective observational study. J Evid Based M Heatlhcare 2018;1:1921–6.
31. Sušilović Grabovac Z, Baković D, Lozo M, Pintarić I, Dujić Ž. Early changes in platelet size and number in patients with acute coronary syndrome. Int J Angiol 2017;26:249–52.
32. Ardakani NM. Evaluation of platelet indices and count in ischemic heart disease patients compared to normal population. Ind J Cardiol 2006;9:17–22.
33. Pervin S, Ferdoushi S, Hossain M, Joarder AI, Sultana T. Elevated mean platelet volume is a marker of acute coronary syndrome. Bangladesh Med J 2013;42:45–50.
34. Dehghani MR, Taghipour-Sani L, Rezaei Y, Rostami R. Diagnostic importance of admission platelet volume indices in patients with acute chest pain suggesting acute coronary syndrome. Indian Heart J 2014;66:622–8.
35. Celik T, Kaya MG, Akpek M, Gunebakmaz O, Balta S, Sarli B, et al. Predictive value of admission platelet volume indices for in-hospital major adverse cardiovascular events in acute ST-segment elevation myocardial infarction. Angiology 2015;66:155–62
36. Huczek Z, Kochman J, Filipiak KJ, Horszczaruk GJ, Grabowski M, Piatkowski R, et al. Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol 2005;46:284–90.
37. Leader A, Pereg D, Lishner M. Are platelet volume indices of clinical use? A multidisciplinary review. Ann Med 2012;44:805–16.
38. Furman MI, Barnard MR, Krueger LA, Fox ML, Shilale EA, Lessard DM, et al. Circulating monocyte-platelet aggregates are an early marker of acute myocardial infarction. J Am Coll Cardiol 2001;38:1002–6.
39. Machlus KR, Italiano JE Jr. The incredible journey: From megakaryocyte development to platelet formation. J Cell Biol 2013;201:785–96.
40. Bakovic D, Pivac N, Eterovic D, Breskovic T, Zubin P, Obad A, et al. The effects of low-dose epinephrine infusion on spleen size, central and hepatic circulation and circulating platelets. Clin Physiol Funct Imaging 2013;33:30–7.
41. Yetkin E. Mean platelet volume not so far from being a routine diagnostic and prognostic measurement. Thromb Haemost 2008;100:3–4.
42. Akin F, Ayca B, Kose N, Altun I, Avsar M, Celik O, et al. Relation of platelet indices to severity of coronary artery disease in patients undergoing primary percutaneous coronary interven tion. Perfusion 2016;31:216–22.
43. Sincer I, Mansiroglu AK, Erdal E, Cosgun M, Aktas G, Gunes Y. Could platelet distribution width predict coronary collateral development in stable coronary artery disease? North Clin Istanb 2020;7:112–7.
44. Murat SN, Duran M, Kalay N, Gunebakmaz O, Akpek M, Doger C, et al. Relation between mean platelet volume and severity of atherosclerosis in patients with acute coronary syndromes. Angiology 2013;64:131–6.
45. Vogiatzis I, Samaras A, Grigoriadis S, Sdogkos E, Koutsampasopoulos K, Bostanitis I. The mean platelet volume in the prognosis of coronary artery disease severity and risk stratification of acute coronary syndromes. Med Arch 2019;73:76–80.
46. Ekici B, Erkan AF, Alhan A, Sayın I, Aylı M, Töre HF. Is mean platelet volume associated with the angiographic severity of coronary artery disease? Kardiol Pol 2013;71:832–8.
47. Khode V, Sindhur J, Kanbur D, Ruikar K, Nallulwar S. Mean platelet volume and other platelet volume indices in patients with stable coronary artery disease and acute myocardial infarction: A case control study. J Cardiovasc Dis Res 2012;3:272–5.
48. Kowara M, Grodecki K, Huczek Z, Puchta D, Paczwa K, Rymuza B, et al. Platelet distribution width predicts left ventricular dysfunction in patients with acute coronary syndromes treated with percutaneous coronary intervention. Kardiol Pol 2017;75:42–7.
49. Ulucan Ş, Keser A, Kaya Z, Katlandur H, Özdil H, Bilgi M, et al. Association between PDW and long term major adverse cardiac events in patients with acute coronary syndrome. Heart Lung Circ 2016;25:29–34.
50. Cetin M, Bakirci EM, Baysal E, Tasolar H, Balli M, Cakici M, et al. Increased platelet distribution width is associated with STsegment elevation myocardial infarction and thrombolysis failure. Angiology 2014;65:737–43.
51. Hu CP, Du Y, Zhu Y, Shi C, Qin Z, Zhao YX. Platelet distribution width on admission predicts in-stent restenosis in patients with coronary artery disease and type 2 diabetes mellitus treated with percutaneous coronary intervention. Chin Med J (Engl) 2018;131:757–63.