The Prognostic Impact of In-Hospital Change in Mean Platelet Volume in Patients With Non-ST-Segment Elevation Myocardial Infarction

Role of combined use of mean platelet volume-to-lymphocyte ratio and monocyte to high-density lipoprotein cholesterol ratio in predicting patients with acute myocardial infarction

BACKGROUND

Atherosclerosis and thrombosis play important roles in the pathophysiology of acute coronary syndrome, with platelet activation and inflammation as the key and initiative factors. Recently mean platelet volume-to-lymphocyte ratio (MPVLR) and monocyte to high-density lipoprotein cholesterol ratio (MHR) have emerged as new prognostic indicators of cardiovascular diseases. However, the predicting effect of the combination of MPVLR and MHR in myocardial infarction has not been reported.

OBJECTIVE

The aim of this study was to investigate the usefulness of combination of MPVLR and MHR in predicting patients with AMI.

METHODS

375 patients who had chest pain or stuffiness were retrospectively enrolled in this study. According to the results of coronary angiography and cardiac troponin, patients were divided into AMI group (n = 284) and control group (n = 91). MPVLR, MHR, Gensini score and Grace score were calculated.

RESULTS

MPVLR and MHR were significantly higher in AMI group than that in control group (6.47 (4.70-9.58) VS 4.88 (3.82-6.44), 13.56 (8.44-19.01) VS 9.14 (7.00-10.86), P < 0.001, respectively). Meanwhile, both were positively correlated with Gensini score and Grace score. Patients with a high level of MPVLR or MHR had an increased risk for AMI (odds ratio (OR) = 1.2, 95% confidence interval (CI) 1.1-1.4, OR = 1.2, 95% CI 1.2-1.3). Combination of MPVLR and MHR identified a greater ROC area than its individual parameters (P < 0.001).

CONCLUSION

Both MPVLR and MHR are independent predictors of AMI. Combination of MPVLR and MHR had higher predicting value in AMI, and thus appears to be a new risk factor and biomarker in the evaluation of risk and severity of atherosclerosis in AMI.

Prognostic value of the combination of GRACE risk score and mean platelet volume to lymphocyte count ratio in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention

The Global Registry of Acute Coronary Events (GRACE) risk score and the mean platelet volume to lymphocyte count ratio (MPVLR) can be used independently to predict adverse outcomes in patients with acute coronary syndromes. However, the level of MPVLR in relation to the GRACE score, and whether a combination of these methods can better predict the clinical adverse outcome of patients with ST-segment elevation myocardial infarction (STEMI), have not been previously examined. Therefore, the aim of the present study was to investigate whether the combination of GRACE risk score and MPVLR is a good predictor of a 30-day major adverse cardiovascular events (MACE) in patients with STEMI. A total of 464 patients with STEMI undergoing percutaneous coronary intervention (PCI) were enrolled, and divided into four groups based on the optimal cut-off values for GRACE score and MPVLR. GRACE score and MPVLR levels were separately recorded during admission. Spearman's rank correlation analysis showed a positive correlation between GRACE score and MPVLR (ρ=0.304; P<0.001). Both GRACE score [hazard ratio (HR), 1.706; 95% CI, 1.435-3.058; P<0.001] and MPVLR level (HR, 1.668; 95% CI, 1.202-2.170; P<0.001) were found to be independent predictors of a 30-day MACE. Additionally, the high MPVLR + high GRACE score group of patients had an HR of 2.455 (95% CI, 1.736-3.188) for a 30-day MACE, when using the low MPVLR + low GRACE score group as a reference. Based on the area under the curve, MPVLR combined with GRACE scores achieved an improved performance in differentiating angiographic no-reflow during a 30-day MACE, compared with individual MPVLR and GRACE scores. Therefore, the present results suggested that the GRACE score may be positively correlated with MPVLR and that their combination accurately predicted the occurrence of short-term MACE in patients with STEMI after PCI.

Mean platelet volume and coronary artery disease

PURPOSE OF REVIEW

To critically review the literature describing links between mean platelet volume (MPV) and cardiovascular disease (CVD). We will focus on coronary artery disease (CAD). The MPV is measured routinely as part of a routine blood count.

RECENT FINDINGS

There is accumulating evidence showing that the MPV may predict CVD, as well as outcomes in patients with CAD. There is also evidence linking MPV and comorbidities (e.g. diabetes mellitus and impaired glycaemic control) that are expected in patients with CAD. The effect on MPV of drugs commonly used to treat CAD has not been clarified, but there is some evidence that they may exert a beneficial effect on the MPV. More specifically, the MPV may predict the effect of antiplatelet drugs (e.g. clopidogrel). There is also evidence relating MPV to stroke, atrial fibrillation, coronary artery ectasia and periprocedural outcomes after percutaneous coronary intervention (PCI).

SUMMARY

Measuring the MPV may prove useful in CVD risk assessment in patients with established CAD or at risk of developing CAD. Overall, there is evidence pointing to the role of MPV as a contributor rather than simple marker of CVD.

Prognostic Value of Pre-Infarction Angina Combined with Mean Platelet Volume to Lymphocyte Count Ratio for No-Reflow and Short-Term Mortality in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Background

The aim of the present study was to investigate the clinical predictive value of pre-infarction angina (PIA) combined with mean platelet volume to lymphocyte count ratio (MPVLR) for no-reflow phenomenon and short-term mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).

Material/Methods

A total of 1009 STEMI patients who had undergone PCI were enrolled and subdivided into 4 groups based on the occurrence of PIA and the presence of MPVLR above or below the cutoff value. Analysis of the predictors of the no-reflow phenomenon and 90-day mortality was conducted. Further, evaluation and comparison of the clinical predictive value of PIA, MPVLR, and their combination were done.

Results

Both MPVLR (odds ratio [OR]=1.476, 95% confidence interval [CI]: 1.401 to 1.756, P<0.001; hazard ratio [HR]=1.430, 95% CI: 1.287 to 1.643, P<0.001) and PIA (OR=0.905, 95% CI: 0.783 to 0.986, P<0.001; HR=0.878, 95% CI: 0.796 to 0.948, P<0.001) were independent predictors of no-reflow phenomenon and 90-day mortality. Spearman’s rank correlation test revealed that MPVLR (r=−0.297, P<0.001), monocyte to lymphocyte count ratio (MLR) (r=−0.211, P<0.001) and neutrophil to lymphocyte count ratio (NLR) (r=−0.389, P<0.001) in peripheral blood were significantly negatively correlated with postoperative left ventricular ejection fraction (LVEF). Upon comparing the area under curve (AUC), the MPVLR combined with PIA achieved better performance in differentiating no-reflow phenomenon (AUC=0.847, 95% CI: 0.821 to 0.874) and 90-day mortality (AUC=0.790, 95% CI: 0.725 to 0.855), than the GRACE score, MPVLR and PIA alone, and had similar performance to all other pairwise combinations of the GRACE score, MPVLR and PIA.

Conclusions

High MPVLR and PIA were independent predictors of the no-reflow phenomenon and 90-day mortality in patients with STEMI after PCI. Moreover, Combined application of MPVLR and PIA can effectively predict the occurrence of the no-reflow phenomenon and 90-day mortality.

Prognostic value of rising mean platelet volume during hospitalization in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Background

The prognostic significance of changes in mean platelet volume (MPV) during hospitalization in ST segment elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (pPCI) has not been previously evaluated. The aim of this study was to determine the association of in-hospital changes in MPV and mortality in these patients.

Methods

Four hundred eighty consecutive STEMI patients were enrolled in this retrospective study. The patients were grouped as survivors (n = 370) or non-survivors (n = 110). MPV at admission, and at 48–72 h was evaluated. Change in MPV (MPV at 48–72 h minus MPV on admission) was defined as ΔMPV.

Results

At follow-up, long-term mortality was 23%. The non-survivors had a high ΔMPV than survivors (0.37 (− 0.1–0.89) vs 0.79 (0.30–1.40) fL, p <  0.001). A high ΔMPV was an independent predictor of all cause mortality ((HR: 1.301 [1.070–1.582], p = 0.008). Morever, for long-term mortality, the AUC of a multivariable model that included age, LVEF, Killip class, and history of stroke/TIA was 0.781 (95% CI:0.731–0.832, p <  0.001). When ΔMPV was added to a multivariable model, the AUC was 0.800 (95% CI: 0.750–0.848, z = 2.256, difference p = 0.0241, Fig. 1). Also, the addition of ΔMPV to a multivariable model was associated with a significant net reclassification improvement estimated at 24.5% (p = 0.027) and an integrated discrimination improvement of 0.014 (p = 0.0198).

Conclusions

Rising MPV during hospitalization in STEMI patients treated with pPCI was associated with long-term 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.

A rise in mean platelet volume during hospitalization for community-acquired pneumonia predicts poor prognosis: a retrospective observational cohort study

Background

Clinical characteristics and the prognostic significance of changes in mean platelet volume (MPV) during hospitalization for community-acquired pneumonia (CAP) have not been investigated.

Methods

Among 976 adults hospitalized for CAP, clinical characteristics, in-hospital outcomes (transfer to the intensive care unit, treatment with mechanical ventilation, prolonged hospital stay and death), and all-cause mortality following discharge, were compared according to ΔMPV (MPV on discharge minus MPV on admission): groups A (no rising MPV, ΔMPV < 0.6 fL) and B (rising MPV, ΔMPV ≥ 0.6 fL).

Results

Groups A and B comprised 83.8% and 16.2% of patients, respectively. Patients with a rise in MPV were more likely to be older, and to present with renal dysfunction, cerebrovascular disorder and severe pneumonia than were patients with no rise in MPV. On discharge, lower values of platelets and higher levels of neutrophils were observed in group B. Rising MPV strongly predicted a need for mechanical ventilation and in-hospital death (the respective relative risks: 2.62 and 6.79; 95% confidence intervals: 1.54–4.45 and 3.48–13.20). The respective 90-day, 3-year and total (median follow-up of 54 months) mortality rates were significantly higher in group B (29.1%, 43.0% and 50.0%) than group A (7.3%, 24.2% and 32.6%), p < 0.001 for all comparisons. A rise in MPV was a powerful predictor of all-cause mortality (relative risk 1.26 and 95% confidence interval 1.11–1.43).

Conclusions

Rising MPV during hospitalization for CAP is associated with a more severe clinical profile than no rise in MPV. A rise in MPV strongly predicts in-hospital and long-term mortality.