Comparison of prognostic significance of mean platelet volume/platelet count with GRACE for long-term prognosis in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

White Blood Cell/Mean Platelet Volume Ratio as a Predictor of Long-Term Outcomes but Not Coronary Artery Disease Severity in Non-ST Elevation Myocardial Infarction Patients

Background White blood cell count (WBC) and mean platelet volume (MPV) have been shown to be hematologic parameters of prognostic significance in acute coronary syndrome. We sought to determine the relationship between the WBC/MPV ratio (WMR), coronary artery disease (CAD) complexity, and long-term clinical outcomes in patients with non-ST elevation myocardial infarction (NSTEMI). Hypothesis WMR has a relationship with the complexity of CAD and long-term clinical outcomes in NSTEMI patients. Methods A total of 289 NSTEMI patients who underwent coronary angiography were divided into two groups according to the median WMR (>970 or ≤970). CAD complexity was assessed with the SYNTAX score. Results The WMR was not associated with the synergy between percutaneous coronary intervention (PCI) with Taxus and cardiac surgery (SYNTAX) score on multivariate linear regression analysis (ß=0.08, 95% CI = -0.76-2.21, p = 0.14). However, it was of prognostic significance on Kaplan-Meier survival analysis in overall patients (log-rank p = 0.03) and in patients with a SYNTAX Score <22 (log-rank p = 0.01). Follow-up data showed that major adverse cardiac events (MACE) (p = 0.02), death (p < 0.001), non-fatal MI (p = 0.03), ischemia-driven revascularization (p = 0.03), and heart failure (p = 0.04) were more frequent in the high WMR group. After adjustment for age, sex, eGFR, troponin levels, and the Global Registry of Acute Coronary Events (GRACE) score in Cox regression models, the association of high WMR with the cumulative incidence of MACE was preserved (overall patients (HR=1.85, 95% CI 1.1-3.12, p=0.02) and patients with a SYNTAX score <22 (HR=2.06, 95% CI 1.15-3.67, p=0.01). Conclusion The WMR was not related to CAD complexity, but it was associated with long-term clinical outcomes in patients with NSTEMI who underwent coronary angiography.

The Prognostic Utility of Mean Platelet Volume in Patients With Acute Coronary Syndrome: A Systematic Review With Meta-Analyses

Mean platelet volume (MPV) is a hematological index that is routinely measured in clinical settings. Although many studies have been conducted to investigate the prognostic significance of MPV in acute coronary syndromes (ACS), the findings have been inconsistent. The goal of this study was to systematically review all current evidence on the association between admission MPV and clinical outcomes after ACS. PubMed, Scopus, Web of Science, and other databases were searched. The primary endpoints were major adverse cardiovascular events (MACE) and mortality. We applied a Knapp and Hartung adjustment, prediction interval calculations and permutation tests during pairwise meta-analyses. A one-stage dose-response meta-analysis was also conducted. The meta-analysis consisted of 41 studies with 33443 participants. Mean platelet volume, as a continuous variable, was associated with the risk of long-term mortality (hazard ratio 1.33, 95% CI 1.19-1.48). After conducting permutation tests and calculation of prediction intervals, this association remained significant. The results for MACE were nonsignificant. Linear models were the best fitted models during dose-response meta-analyses, trends for nonlinearity were significant for long-term endpoints. Admission MPV was associated with long-term mortality in ACS patients, with nonlinear associations between MPV levels and long-term clinical outcomes.

Mean platelet volume/platelet count ratio as a predictor of stent thrombosis in patients with ST-segment-elevation myocardial infarction

BACKGROUND

Despite the important role of some haematological parameters in tendency to thrombosis is known, their relationship with long-term stent thrombosis (ST) remains unclear.

AIMS

This study aimed to investigate the association between the mean platelet volume (MPV) to platelet count (PC) ratio and long-term ST and mortality in patients with ST-segment-elevation myocardial infarction (STEMI) treated successfully by primary percutaneous coronary intervention (pPCI).

METHODS

In a retrospective cohort study, according to their baseline MPV/PC ratios, 3667 consecutive STEMI patients undergoing pPCI were divided into three groups: tertile 1 (T1) (n = 1222, 0.357 ≥ MPV/PC ≥ 0.043), tertile 2 (T2) (n = 1222, 0.033 < MPV/PC < 0.043) and tertile 3 (T3) (n = 1223, 0.009 ≤ MPV/PC ≤ 0.032). Patients were followed up with for 5 years, focusing on ST and all-cause mortality outcomes.

RESULTS

Patients with T1 displayed a greater 5-year ST rate, including a 2.76-fold greater (95% confidence interval 1.68-10.33) rate than that of patients with T3, who had the lowest rates and were used as the reference group. Meanwhile, the 5-year mortality rate was similarly higher among patients with T1 by 1.72 times (95% confidence interval 1.33-2.22) relative to that among patients with T3. These significant relationships persisted even after adjustment for all confounders.

CONCLUSION

We found that higher MPV/PC ratios were associated with long-term ST and mortality. The MPV/PC ratio may constitute both a rapid and an easily obtainable parameter for identifying reliably high-risk patients who have undergone pPCI.

Mean Platelet Volume/Platelet Count Ratio and Culprit Plaque Morphologies: An Optical Coherence Tomography Study in Patients with ST Segment Elevation Myocardial Infarction

This study aimed to investigate the predictive value of mean platelet volume/platelet count ratio (MPR) for coronary plaque features in patients with ST segment elevation myocardial infarction (STEMI). A total of 275 STEMI patients undergoing preintervention optical coherence tomography examination were included, with 142 categorized as plaque rupture (PR) and 133 as plaque erosion (PE). Multivariable logistic regression showed higher MPR was an independent predictor of PR (tertile 3 vs tertile 1, odds ratio: 6.257, 95% confidence interval: 1.586-24.686, P = 0.009). MPR showed better diagnostic performance than other platelet indices. The optimal MPR threshold for diagnosing PR was 0.0473 (sensitivity: 0.721, specificity: 0.647). When added to models of established risk factors, MPR significantly improved the predictive accuracy of PR (area under the curve: 0.767 vs 0.722, P _difference = 0.004). In conclusion, for STEMI patients, MPR was an independent predictor of PR and improved diagnostic performance for PR.

Immature Platelets and Risk of Cardiovascular Events among Patients with Ischemic Heart Disease: A Systematic Review

BACKGROUND

 Immature platelets are larger and may be more thrombogenic than mature platelets. This systematic review included studies on the association between mean platelet volume (MPV), immature platelet count (IPC), and immature platelet fraction (IPF) and the risk of major cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) or stable coronary artery disease (CAD).

METHODS

 The literature search included studies in PubMed, Embase, Web of Science, and Cochrane Library. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Effect estimates that included multivariate adjusted odds ratios, relative risks, or hazard ratios were extracted.

RESULTS

 Forty-two studies were identified. High MPV was positively associated with MACE in 20 of 26 studies of patients with ACS, four of five studies in patients with stable CAD, and in all six studies comprising a combined population with ACS and stable CAD. Using continuous models of MPV in patients with ACS, effect estimates varied from 0.90 (95% confidence interval [CI]: 0.95-1.03) to 1.66 (95% CI: 1.32-2.09). The strength of these associations was broadly similar among patients with stable CAD and in combined populations. Five studies investigated IPC or IPF as exposures and all reported positive associations with MACE among patients with ACS, stable CAD, or in combined populations.

CONCLUSION

 This review demonstrated clear evidence for positive associations between measures of immature platelets and subsequent risk of MACE in acute and stable ischemic heart disease patients.

Mean platelet volume/platelet count ratio predicts severe pneumonia of COVID-19

Background

Although platelet mean volume/platelet count ratio (MPR) is considered to be a crucial marker of inflammatory and infectious diseases, the relationship between MPR and novel coronavirus infectious disease 2019 (COVID‐19) remains unclear.

Methods

In this retrospective study, 85 patients with confirmed COVID‐19 were enrolled and divided into low and high MPR group. Data from repeated measures were compared by the generalized estimating equations. Cox regression analyses were performed to assess the impact of MPR on the incidence of severe pneumonia (SP), with inverse probability of treatment weighting (IPTW) used to reduce confounding bias. The primary outcome is the incidence of SP of COVID‐19.

Results

During follow‐up, 17 (20.0%) patients were developed to SP. Compared with mild patients, patients with SP developed showed a higher MPR level at baseline, day 1, day 2, and day 3 after admission (P = .005, P = .015, P = .009, and P = .032, respectively). Kaplan‐Meier method showed a higher incidence of SP in the high MPR group than the low MPR group (log‐rank test = 10.66, P = .001). After adjustment, high MPR was associated with an elevated incidence of SP (HR, 5.841, 95% CI, 1.566‐21.791, P = .009). The IPTW method also suggested that MPR was a significant factor related to the incidence of SP (HR, 8.337, 95% CI, 4.045‐17.182, P < .001).

Conclusion

High MPR level is an independent risk factor for severe pneumonia in patients with COVID‐19.

The Biomarkers for Acute Myocardial Infarction and Heart Failure

The use of a large number of cardiovascular biomarkers, meant to complement the use of the electrocardiogram, echocardiography cardiac imaging, and clinical symptom assessment, has become a routine in clinical diagnosis, differential diagnosis, risk stratification, and prognosis and guides the management of patients with suspected cardiovascular diseases. There is a broad consensus that cardiac troponin and natriuretic peptides are the preferred biomarkers in clinical practice for the diagnosis of the acute coronary syndrome and heart failure, respectively, while the roles and possible clinical applications of several other potential biomarkers are still under study. This review mainly focuses on the recent studies of the roles and clinical applications of troponin and natriuretic peptides, which seem to be the best-validated markers in distinguishing and predicting the future cardiac events of patients with suspected cardiovascular diseases. Additionally, the review briefly discusses some of the large number of potential markers that may play a more prominent role in the future.

Is Migraine an MPV-Related Disease? An Observational Study of Polish Neurological Patients

Many studies have found correlations between abnormal MPV and clinical reactivity in a variety of diseases. In the present paper, we sought MPV-related neurological diseases that are less frequently reported in the literature. The electronic medical records of 852 neurological patients with mean platelet volume (MPV) measurements (F = 45%, age = 55.7 ± 18.7, 8–104) were searched after the patients had received a diagnosis of a neurological disease (new and old episodes) according to the nine classes of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). A set of consecutive statistical methods (i.e., cluster analysis, segmented regression, linear correlation, propensity score matching, and mixed effects Poisson regression) were used to establish a link between MPV and neurological disease. A statistically significant (p < 0.05) relationship with MPV was found only in pain syndrome patients, with seven out of eight clinically diagnosed migraine episodes. With all other ICD-10 classes of neurological diseases, the effect of MPV was found to be nonsignificant (p > 0.05). MPV may implicate a clinical relationship with pain syndrome and migraine episodes. More complex statistics could help analyse data and find new correlations.

The prognostic value of mean platelet volume to platelet count ratio in older patients with non-ST elevation acute coronary syndrome receiving primary percutaneous coronary intervention: a retrospective study

BACKGROUND

The aim of this study was to investigate the value of the mean platelet volume to platelet count (MPV/P) ratio for predicting in-hospital and long-term cardiac mortality in older non-ST elevation-acute coronary syndrome (NSTE-ACS) patients after primary percutaneous coronary intervention (PCI).

METHODS

We retrospectively reviewed 452 older NSTE-ACS patients who received primary PCI. The patients were divided into two groups based on MPV/P ratios: high MPV/P group (N.=150) defined as a value in the third tertile (>0.056628) and low MPV/P group (N.=302) in the lower two tertiles (≤0.056628). Clinical outcomes included non-fatal reinfarction, heart failure, and cardiac mortality.

RESULTS

Multivariate analyses showed that high MPV/P and MPV values were independent predictors of cardiac mortality. The in-hospital cardiac mortality of the high MPV/P group was higher than the low MPV/P group (1.3% vs. 14.7%, P<0.001). The rates of heart failure and cardiac mortality in one year were significantly higher in the high MPV/P group compared to the low MPV/P group (P<0.05). The cut-off value of MPV/P for predicting cardiac death was 0.067107, with a sensitivity of 0.707 and a specificity of 0.868. MPV/P was superior to MPV (z=9.235, P<0.001) for predicting cardiac mortality.

CONCLUSIONS

High MPV/P and MPV values are independent predictors of cardiac mortality in older patients with NSTE-ACS receive primary PCI. Moreover, MPV/P is better than MPV for predicting cardiac mortality.

Predictive Value of Mean Platelet Volume/Platelet Count for Prognosis in Acute Myocardial Infarction

Increased mean platelet volume (MPV) has been associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). We aim to assess whether MPV/platelet count (MPV/PC) ratio is a useful marker to predict long-term prognosis in patients with STEMI undergoing PCI. Moreover, the prognostic accuracy of MPV/PC ratio is compared with MPV. 962 consecutive patients with STEMI treated with P-PCI were considered. According to the admission MPV/PC values, the population was divided into two groups: high MPV/PC group (n = 320, MPV/PC ≥ 0.055) and low MPV/PC group (n = 642, MPV/PC < 0.055). Multivariate analysis showed that high MPV/PC was an independent predictor of major adverse cardiovascular event (MACE; hazard ratio [HR]: 1.121, 95% confidence interval [CI]: 1.056-1.190, P < 0.01), all-cause mortality (HR: 1.109, 95% CI: 1.016-1.209, P = 0.020), cardiac mortality (HR: 1.141, 95% CI: 1.038-1.253, P = 0.006), nonfatal myocardial reinfarction (HR: 1.148, 95% CI: 1.044-1.262, P = 0.004), and unplanned repeat revascularization (HR: 1.073, 95% CI: 1.007-1.144, P = 0.030), respectively. MPV/PC ratio has good accuracy for predicting MACE (the area under the receiver-operating characteristic curve: 0.764), and the cut-off value was 0.054 with a sensitivity of 0.813 and a specificity of 0.662. The discriminatory performance of MPV/PC ratio was better than MPV for predicting MACE (MPV/PC ratio versus MPV: z = 2.285, P = 0.022), in patients with STEMI undergoing P-PCI. MPV/PC ratio is able to but better than MPV to predict long-term adverse outcomes in patients with STEMI undergoing P-PCI.

ACTION (acute coronary treatment and intervention outcomes network) registry-GWTG (get with the guidelines) risk score predicts long-term mortality in acute myocardial infarction

This study aimed to test the predictive performance of the updated ACTION, GRACE, and CADILLAC risk scores (RS’s) for long-term mortality in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). The study included individuals from 2 independent cohorts: derivation cohort (N = 1901) and validation cohort (N = 728). From the derivation cohort, we used Cox regression analysis to determine that the updated ACTION, GRACE, and CADILLAC RS's were associated with long-term mortality. The concordance (C) statistics of the 3 RS's were 0.682, 0.703 and 0.734, respectively. We used the validation cohort to validate the results. Moreover, the discriminatory performance of the updated ACTION RS for predicting long-term mortality in both the respective derivation and validation cohorts was similar to the discriminatory performance of the GRACE and CADILLAC RS's (ACTION vs. GRACE: z = 0.684, p = 0.494; ACTION vs. CADILLAC: z = 1.638, p = 0.101) and (ACTION vs. GRACE: z = 0.460, p = 0.646; ACTION vs. CADILLAC: z = 0.290, p = 0.772). Despite their development over a decade ago, GRACE and CADILLAC RS's maintain good performance for predicting the long-term mortality of AMI patients undergoing PCI. As a new risk model, the updated ACTION RS also predicts long-term mortality, and its discriminatory performance is similar to that of the GRACE and CADILLAC RS’s.

Derivation and Validation of Shock Index as a parameter for Predicting Long-term Prognosis in Patients with Acute Coronary Syndrome

The objective of this study was to examine whether shock index (SI), defined by ratio of heart rate and systolic blood pressure, can predict long-term prognosis of acute coronary syndrome (ACS) in patients undergoing percutaneous coronary intervention (PCI) and to compare prognostic accuracy of SI with the Global Registry of Acute Coronary Events (GRACE) risk score. This study included individuals from 2 independent cohorts: derivation cohort (n = 2631) and validation cohort (n = 963). In the derivation cohort, we derived that higher admission SI was associated with a greater risk of long-term all-cause mortality [HR = 4.104, 95% CI 1.553 to 10.845, p = 0.004] after adjusting for covariates. We validated this finding in the validation cohort [HR = 10.091, 95% CI 2.205 to 46.187, p = 0.003]. Moreover, admission SI had similar performance to the GRACE score in determining all-cause mortality risk in both cohorts (derivation cohort, admission SI vs. GRACE, z = 1.919, p = 0.055; validation cohort, admission SI vs. GRACE, z = 1.039, p = 0.299). In conclusion, admission SI is an independent predictor of adverse outcome in ACS patients undergoing PCI, and can identify patients at high risk of death. SI and the GRACE score showed similar performance in predicting all-cause mortality, and SI is more readily obtained than the GRACE score.