Relationship of admission haematological indices with infarct-related artery patency in patients with acute ST-segment elevation myocardial infarction treated with primary angioplasty

Relation of red cell distribution width to contrast-induced acute kidney injury in patients undergoing a primary percutaneous coronary intervention

BACKGROUND AND AIM

We investigated the utility of the preprocedural red cell distribution width (RDW) for predicting contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment-elevation myocardial infarction (STEMI) who underwent a primary percutaneous coronary intervention.

MATERIALS AND METHODS

A total of 630 consecutive patients who were routinely referred to coronary angiography for STEMI were included in the present study.

RESULTS

CI-AKI was observed in 79 patients (12.5%). The RDW, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the mean platelet volume were significantly higher in the CI-AKI group than in the non-CI-AKI group (P<0.001, P=032, P=0.025, and P=0.039, respectively). Serum total bilirubin and direct bilirubin levels were not different among the study groups. Using multivariate logistic regression analysis, we found that left ventricular ejection fraction [odds ratio (OR)=0.972, 95% confidence interval (CI) 0.945-0.998, P=0.033], estimated glomerular filtration rate (OR=0.970, 95% CI 0.959-0.981, P<0.001), contrast volume (OR=1.007, 95% CI 1.002-1.012, P=0.009), and RDW (OR=1.406, 95% CI 1.120-1.792, P=0.005) were independent predictors of CI-AKI.

CONCLUSION

Red blood cell distribution width, an inexpensive and easily measurable laboratory variable, is associated independently with the development of CI-AKI. Our data suggest that RDW may be a useful marker in CI-AKI risk stratification.

Impact of Mean Platelet Volume on Long-Term Mortality in Chinese Patients with ST-Elevation Myocardial Infarction

We investigated the association between mean platelet volume (MPV) and risk of all-cause mortality in Chinese patients with ST-Elevation Myocardial Infarction (STEMI). We enrolled 1836 patients with STEMI in Xuanwu Hospital from January 2008 to December 2013. Based on MPV, patients were categorized into the following groups: <9.5 fL (n = 85), 9.5–11.0 fL (n = 776), 11.1–12.5 fL (n = 811) and >12.5 fL (n = 164), respectively. Mean duration of follow-up was 56.9 months, and 197 patients (10.7%) died during follow-up. All-cause mortality rates were compared between groups. The lowest mortality occurred in patients with MPV between 9.5–11.0 fL, with a multivariable-adjusted hazard ratio (HR) of 1.15(95%CI 0.62–1.50), 1.38(95%CI 1.20–1.68), and 1.72(95%CI 1.41–1.96) in patients with MPV of <.5, 11.1–12.5 and >12.5 fL, respectively. Therefore, increased MPV was associated with all-cause mortality in Chinese patients with STEMI. MPV might be useful as a marker for risk stratification in Chinese patients with STEMI.

Neutrophil to lymphocyte ratio in acute ST-segment elevation myocardial infarction

BACKGROUND

Spontaneous early patency of infarct-related artery (IRA) on arrival for primary percutaneous coronary intervention is associated with better short- and long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to investigate whether the hemographic parameters on admission are associated with spontaneous IRA patency.

METHODS

This was a retrospective study of 1,625 patients with acute STEMI who underwent primary percutaneous coronary intervention<12 hours after the onset of symptoms.

RESULTS

Angiography showed patent IRA (prethrombolysis in myocardial infarction [TIMI] grade 3 flow) in 160 (9.8%) patients. Neutrophil count on admission (7.8±2.4×10³/μL versus 9.7±3.8×10³/μL; P<0.001) was significantly lower and lymphocyte count (2.4±1.0×10³/μL versus 1.9±1.1×10³/μL; P<0.001) on admission was significantly higher in the patent IRA group. Neutrophil to lymphocyte ratio (NLR) was significantly lower in the patent IRA group (4.1±3.2 versus 6.9±5.5; P<0.001). Admission leukocyte counts (13±4.0×10³/μL versus 12±3.4×10³/μL; P<0.001) and NLR (7.2±5.8 versus 5.5±4.4; P<0.001) of the patients with TIMI thrombus score≥4 were significantly higher than patients with TIMI thrombus score<4. In the multivariate analysis, NLR≥4.5 (3.17 [95% confidence interval: 2.04-4.92]; P<0.001) was found to be independently predicting an occluded IRA on initial angiography with a sensitivity of 62.7% and a specificity of 70%.

CONCLUSIONS

NLR on admission is significantly related to angiographic thrombus burden and spontaneous early IRA patency in patients with acute STEMI.

Short-term effects of aspirin and clopidogrel on mean platelet volume among patients with acute coronary syndromes. A single-center prospective study

Mean platelet volume (MPV) has been correlated with platelet reactivity, thus its changes might be used to monitor the effects of antiplatelet therapy. However, no data have been reported on platelet remodelling after antiplatelet therapy. The aim of the current study was to investigate the short-term effects of oral antiplatelet therapy on MPV. Our population is represented by 62 consecutive patients with acute coronary syndrome (ACS), who did not receive GpIIb-IIIa inhibitors. We measured MPV before starting dual antiplatelet therapy, at day 1, day 2, and day 3-5 from starting adjunctive antiplatelet therapy. We additionally analyzed the relationship between platelet aggregation and MPV at admission by Multiplate in patients who were on chronic aspirin therapy. We observed a significant paradoxical increase in MPV, with a reduction in platelet count. We observed at all time intervals a significant inverse relationship between MPV and platelet count (T0: r = -0.44, P < 0.0001; T1: r = -0.36, P = 0.006; T2: r = -0.3, P = 0.026; T3-5: r = -0.29, P = 0.046). No relationship was observed between MPV and the extent of platelet aggregation inhibition by aspirin. This study showed a paradoxical increase in MPV after starting antiplatelet therapy. In addition, we did not observe any relationship between baseline MPV and the extent of platelet aggregation inhibition by aspirin. Thus, larger MPV does not imply higher platelet reactivity and may not be considered to monitor platelet reactivity and the efficacy of antiplatelet therapies.

Increased expression of visfatin in monocytes and macrophages in male acute myocardial infarction patients

We demonstrated that visfatin expressed in monocytes and neutrophils and increased their reactivity in male acute ST-segment elevation myocardial infarction patients. Furthermore, visfatin was strongly appeared in lipid rich coronary rupture plaques and macrophages. These results suggest another explanation about leukocytes mediated visfatin that may play a pathogenesis role in coronary vulnerable plaques rupture.

The relationship between platelet reactivity and infarct-related artery patency in patients presenting with a ST-elevation myocardial infarction

Both heightened platelet reactivity and an occluded infarct related artery (IRA) on initial angiography and at the time of primary percutaneous coronary intervention (PCI) are associated with a worsened clinical outcome in patients with ST-elevation myocardial infarction (STEMI). However, the relationship between platelet reactivity and IRA patency has not yet been established. Consecutive STEMI-patients were enrolled in this study. Patients who had TIMI-flow (thrombolysis in myocardial infarction) 0 or 1 on initial angiography constituted the occluded IRA group and patients having TIMI-flow 2 or 3 comprised the IRA patent group. Platelet function measurements were performed using the PFA-100 COL/ADP cartridge and light transmittance aggregometry without agonist (spontaneous) and after stimulation with adenosine diphosphate (ADP) and arachidonic acid (AA). Ninety-nine patients were enrolled, of whom 49 presented with an occluded IRA. Multivariate analysis identified the following independent factors to be associated with an occluded IRA; short COL/ADP closure time (ORper quartile increase=0.60; 95% CI, 0.39-.93; p=0.02), the 20 μM ADP-induced light transmittance aggregometry (ORper quartile increase =1.77; 95% CI, 1.15-2.73; p=0.01) and leukocyte counts (odds ratio [OR]=1.21; 95% CI, 1.05-1.39; p = 0.008). In conclusion, heightened platelet reactivity and elevated leukocyte counts are associated with an occluded IRA upon presentation in STEMI-patients. These results emphasise the importance of potent antithrombotic therapy early after the onset of symptoms, to obtain early recanalisation of the IRA.

Increased mean platelet volume in patients with acute coronary syndromes

CONTEXT

Despite remarkable progress, the diagnosis of acute coronary syndromes (ACS) is still challenging.

OBJECTIVE

The mean platelet volume (MPV), a simple and reliable indicator of platelet size that correlates with platelet activation, might be an emerging cardiovascular risk marker and potentially helpful in stratifying cardiovascular risk.

DESIGN

We analyzed MPV values in 2304 adult patients who were consecutively admitted during a 1-year period to the emergency department of the University Hospital of Verona for chest pain suggestive of ACS. In all patients, a baseline blood sample was collected for routine hematologic testing, whereas cardiac troponin T measurements were collected both at baseline and after 4, 6, and 12 hours.

RESULTS

A total of 456 patients (19.8% of total) had ACS. These patients, all having cardiac troponin T levels of 0.03 ng/mL or greater in addition to ischemic electrocardiographic changes, had higher MPV values than non-ACS patients with normal cardiac troponin T levels (median, 8.0 fL [5th to 95th percentiles, 6.7-10.0 fL] versus median, 7.4 fL [5th to 95th percentiles, 6.5-9.5 fL]; P < .001). The diagnostic accuracy of MPV, calculated as the area under the curve by the receiver operating characteristic analysis, was 0.661 (P < .001). At the 9.0-fL cutoff, the negative and positive predictive values of MPV were 83% and 43%, respectively.

CONCLUSIONS

Because MPV is a simple and inexpensive laboratory measurement, it might be considered a useful rule-out test along with other conventional cardiac biomarkers for the risk stratification of ACS patients admitted to the emergency departments.

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

BACKGROUND AND AIMS

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).

CONCLUSION

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.