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.
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.
Estévez-Loureiro
Rodrigo
R
Department of Cardiology, Complejo Hospitalario Universitario A Coruña, As Xubias, 84, 15006, A Coruña, Spain. roiestevez@hotmail.com
Salgado-Fernández
Jorge
J
Marzoa-Rivas
Raquel
R
Barge-Caballero
Eduardo
E
Pérez-Pérez
Alberto
A
Noriega-Concepción
Victor
V
Calviño-Santos
Ramón
R
Vázquez-Rodríguez
José Manuel
JM
Vázquez-González
Nicolás
N
Castro-Beiras
Alfonso
A
Kaski
Juan Carlos
JC
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
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab