ARTICLE
Mean Platelet Volume on Admission Predicts Impaired Reperfusion and Long-Term Mortality in Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention
Zenon Huczek, MD*,*,
Janusz Kochman, MD*,
Krzysztof J. Filipiak, MD, PhD*,
Grzegorz J. Horszczaruk, MD*,
Marcin Grabowski, MD*, ,
Radoslaw Piatkowski, MD*,
Joanna Wilczynska, MD, PhD*,
Andrzej Zielinski, MD*,
Bernhard Meier, MD, FACC, FESC and
Grzegorz Opolski, MD, PhD, FESC*
* 1st Department of Cardiology, The Medical University of Warsaw, Warsaw, Poland
Department of Medical Informatics, The Medical University of Warsaw, Warsaw, Poland
Department of Cardiology, Swiss Cardiovascular Center, Bern, Switzerland
Manuscript received December 21, 2004;
revised manuscript received March 15, 2005,
accepted March 29, 2005.
* Reprint requests and correspondence: Dr. Zenon Huczek, Department of Cardiology, The Medical University of Warsaw, Central University Hospital, 1a Banacha Street, 02-097 Warszawa, Poland (Email: zhuczek{at}wp.pl).
OBJECTIVES: We sought to determine the prognostic value of mean platelet volume (MPV) for angiographic reperfusion and six-month mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).
BACKGROUND: Mean platelet volume is predictive of unfavorable outcome among survivors of STEMI when measured after the index event. No data are available for the value of admission MPV in patients with STEMI treated with primary PCI.
METHODS: Blood samples for MPV estimation, obtained on admission in 398 consecutive patients presenting with STEMI, were measured before primary PCI. Follow-up up to six months was performed.
RESULTS: No-reflow was significantly more frequent in patients with high MPV ( 10.3 fl) compared with those with low MPV (<10.3 fl) (21.2% vs. 5.5%, p < 0.0001). The MPV was correlated strongly with corrected Thrombolysis In Myocardial Infarction frame count (CTFC) (r = 0.698, p < 0.0001). Kaplan-Meier survival analysis showed six-month mortality rate of 12.1% in patients with high MPV versus 5.1% in low MPV group (log rank = 6.235, p = 0.0125). After adjusting for baseline characteristics, high MPV remained a strong independent predictor of no-reflow (odds ratio [OR] 4.7, 95% confidence interval [CI] 2.3 to 9.9, p < 0.0001), CTFC 40 (OR 10.1, 95% CI 5.7 to 18.1, p < 0.0001), and mortality (OR 3.2, 95% CI 1.1 to 9.3, p = 0.0084). Abciximab administration resulted in significant mortality reduction only in patients with high MPV values (OR 0.02, 95% CI 0.01 to 0.48, p = 0.0165).
CONCLUSIONS: Mean platelet volume is a strong, independent predictor of impaired angiographic reperfusion and six-month mortality in STEMI treated with primary PCI. Apart from prognostic value, admission MPV may also carry further practical, therapeutic implications.
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Abbreviations and Acronyms
| | CI = confidence interval | | CTFC = corrected TIMI frame count | | EDTA = ethylenedinitro tetraacetic acid | | IRA = infarct-related artery | | OR = odds ratio | | MPV = mean platelet volume | | PCI = percutaneous coronary intervention | | ROC = receiver-operating characteristic | | STEMI = ST-segment elevation myocardial infarction | | TnI = troponin I |
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