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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Mean platelet volume is associated with poor postinterventional myocardial blush grade in patients with ST-segment
Bahadir Sarli1, Ahmet O Baktir, Hayrettin Saglam
1Department of Cardiology, Kayseri Education and Research Hospital, 38010 Kayseri, Turkey. drsarli@yahoo.com
Insights
Admission mean platelet volume (MPV) is linked to poor myocardial blush grade (MBG) in ST-elevation myocardial infarction (STEMI) patients. Higher MPV indicates reduced microvascular reperfusion after primary PCI, impacting mortality and stent thrombosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Platelet Physiology
Background:
- Microvascular dysfunction and poor myocardial reperfusion occur despite restored epicardial blood flow in STEMI patients.
- Myocardial blush grade (MBG) is a key indicator of microvascular patency and a predictor of outcomes post-PCI.
- Mean platelet volume (MPV) reflects platelet reactivity and may influence reperfusion success.
Purpose of the Study:
- To investigate the association between admission MPV and post-PCI MBG in STEMI patients with TIMI grade 3 flow.
- To determine if MPV can predict microvascular reperfusion quality after primary PCI.
Main Methods:
- A study group of 310 STEMI patients with TIMI grade 3 flow post-PCI was analyzed.
- Admission blood samples were collected for MPV measurement.
- MBG was assessed post-angioplasty, categorizing patients into poor (MBG 0-1) and normal (MBG 2-3) blush groups.
Main Results:
- Patients with poor MBG exhibited significantly higher admission MPV, peak CK-MB levels, and WBC count, with lower LVEF.
- Linear regression confirmed a significant association between admission MPV and post-interventional MBG (coefficient=0.598, P<0.001).
- Poor MBG was linked to increased cardiovascular mortality and stent thrombosis at 3 months.
Conclusions:
- Admission MPV is a significant predictor of poor post-interventional MBG in STEMI patients undergoing primary PCI.
- Elevated MPV may indicate impaired microvascular reperfusion, contributing to adverse outcomes.
Objective:
In a significant proportion of patients with ST-elevation myocardial infarction (STEMI), microvascular and myocardial reperfusion cannot be regained despite successfully restored thrombolysis in myocardial infarction (TIMI) grade 3 epicardial blood flow. Myocardial blush grade (MBG) is a reliable marker for microvascular patency and predicts short-term and long-term mortality after primary percutaneous coronary intervention (PCI) in patients with acute STEMI, independent of other variables. Mean platelet volume (MPV), a unique measure of platelet size, is an indicator of platelet reactivity. In this study, we aimed to investigate the relation of admission MPV with postinterventional MBG in patients with STEMI and TIMI grade 3 flow at infarct artery after primary PCI.
Materials And Methods:
Three hundred and ten patients were selected as a study group among patients with STEMI and TIMI grade 3 epicardial blood flow after primary PCI. Blood samples for analysis were obtained during the initial evaluation of patients at the emergency department. MBGs of patients were classified at the end of angioplasty. Patients with MBG 0 and 1 were defined as having poor myocardial blush and patients with MBG 2 and 3 were defined as having normal myocardial blush.
Results:
Patients with poor myocardial blush had higher admission MPV (10.5±1.3 to 9.1±1 fl, P<0.001), higher peak creatine kinase myocardial band isoenzyme levels (260±53 to 190±38 U/l, P<0.001), higher white blood cell count (11.3±4 to 10.3±3×10/μl, P=0.012), and lower left ventricular ejection fraction (42±7 to 51±8%, P<0.001) compared with patients with normal myocardial blush. Linear regression analysis showed that admission MPV was significantly associated with postinterventional MBG (coefficient=0.598, P<0.001). Cardiovascular mortality (13-5%, P=0.013) and acute-subacute stent thrombosis at 3 months (12-8%, P=0.028) were significantly higher in patients with poor postinterventional myocardial blush compared with those with normal myocardial blush.
Conclusion:
The MPV measured at admission is significantly associated with poor postinterventional MBG in patients with STEMI and TIMI grade 3 flow at infarct artery after primary PCI.
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