title: Mean platelet volume predicts patency of the infarct-related artery before mechanical reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: OBJECTIVE
  Patency of infarct-related artery (IRA) before mechanical reperfusion with primary percutaneous coronary intervention (PPCI) has been associated with better prognosis in patients with ST-Elevation myocardial infarction (STEMI). Mean platelet volume (MPV) increases in STEMI patients and may be associated with increased thrombotic potential. In STEMI patients scheduled for PPCI we sought to assess whether mean platelet volume (MPV), as measured at admission, correlates with "spontaneous" reperfusion of the IRA and short-term clinical outcome.
  
  
  METHODS
  Blood samples were obtained on hospital admission in 617 consecutive patients (82% men; age 64 + or - 12 years) with STEMI, before PPCI. 372 (61%) patients were treated with the GP IIb/IIIa blocker abciximab. The main study endpoint was mortality at 30 days.
  
  
  RESULTS
  MPV was significantly lower in patients with basal TIMI flow grade 2 -3 compared to patients with TIMI grade 0-1 (median, 9 vs. 8.5 fL, p<0.0001). After adjustment, MPV remained an independent predictor of the patency of the IRA (OR 0.63, CI 95% 0.51 - 0.78). A cut off value of 8.95 fL had a predictive negative value of 82% to identify patients with patent IRA. Using this cut point, and after adjusting for confounders, MPV was an independent predictor of 30-day mortality (HR 2.92, CI 95% 1.36 - 6.29). When patients were subdivided according to abciximab use, MPV was a marker of worse outcome but only in patients who did not receive abciximab (HR 3.67, CI 95% 1.13 - 11.49).
  
  
  CONCLUSIONS
  An increased MPV is an independent predictor of both a patent IRA (TIMI flow 2 or 3 before PPCI) and 30-day mortality. This marker may be able to identify patients requiring more aggressive antiplatelet therapy.
authors.affiliation: Department of Cardiology, Complejo Hospitalario Universitario A Coruña, As Xubias, 84, 15006, A Coruña, Spain. roiestevez@hotmail.com
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Estévez-Loureiro
authors.forename: Jorge
authors.initials: J
authors.lastname: Salgado-Fernández
authors.forename: Raquel
authors.initials: R
authors.lastname: Marzoa-Rivas
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.forename: Alberto
authors.initials: A
authors.lastname: Pérez-Pérez
authors.forename: Victor
authors.initials: V
authors.lastname: Noriega-Concepción
authors.forename: Ramón
authors.initials: R
authors.lastname: Calviño-Santos
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Vázquez-Rodríguez
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vázquez-González
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001792:Blood Platelets / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011379:Prognosis; D016019:Survival Analysis; D014654:Vascular Patency
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab