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Published on: January 28, 2020
Prognostic value of a decrease in mean platelet volume, platelet distribution width, and platelet-large cell ratio
Emir Bećirović1, Kenana Ljuca2, Minela Bećirović1
1Internal Medicine Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
Insights
A decrease in platelet distribution width (PDW) after clopidogrel treatment predicts major adverse cardiovascular events (MACEs) in non-ST-elevation myocardial infarction (NSTEMI) patients. A PDW decrease below 9.9% indicates higher MACE risk and lower survival rates.
Area of Science:
- Cardiology
- Hematology
- Clinical Medicine
Background:
- Platelet indices like PDW, P-LCR, and MPV are increasingly recognized for their role in cardiovascular disease.
- Assessing prognostic markers in acute myocardial infarction without ST-segment elevation (NSTEMI) is crucial for patient management.
Purpose of the Study:
- To investigate the prognostic value of changes in platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and mean platelet volume (MPV) for major adverse cardiovascular events (MACEs) in NSTEMI patients treated with clopidogrel.
- To determine if a specific threshold of PDW decrease can predict short-term MACE risk.
Main Methods:
- Prospective observational cohort study of 170 NSTEMI patients.
- Measurement of PDW, P-LCR, and MPV on hospital admission and 24 hours post-clopidogrel treatment.
- One-year follow-up for MACE assessment, utilizing Cox regression and Kaplan-Meier analyses.
Main Results:
- A significant association was found between a decrease in PDW and reduced incidence of MACEs and improved overall survival.
- Patients with a PDW decrease <9.9% 24 hours post-treatment exhibited significantly higher MACE rates and lower survival.
- No significant prognostic value was observed for decreases in MPV or P-LCR.
Conclusions:
- A decrease in PDW <9.9% 24 hours after clopidogrel initiation serves as a valuable prognostic marker for short-term MACE risk in NSTEMI patients.
- This finding may aid in the risk stratification of NSTEMI patients treated with clopidogrel.
- Platelet distribution width holds prognostic significance in NSTEMI management.
Abstract:
The current study aimed to explore whether the level of decrease in platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and mean platelet volume (MPV) has prognostic value for major adverse cardiovascular events (MACEs) in acute myocardial infarction without ST-segment elevation (NSTEMI) treated with clopidogrel. In this prospective observational cohort study, PDW, P-LCR, and MPV were determined on admission at the hospital and 24 h after clopidogrel treatment in 170 non-STEMI patients. MACEs were assessed over a one-year follow-up period. Using the Cox regression test, a decrease in PDW showed a significant association with the incidence of MACEs (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.66-0.99, p = 0.049) and overall survival rate (OR 0.95, 95% CI = 0.91-0.99, p = 0.016). Patients with a decrease in PDW<9.9% had a higher incidence of MACEs (OR 0.42, 95% CI = 0.24-0.72, p = 0.002) and a lower survival rate (OR 0.32, 95% CI = 0.12-0.90, p = 0.03) than patients who had a decrease in PDW < 9.9%. In the Kaplan-Meier analysis using log-rank test, patients who had a decrease in PDW < 9.9% had an increased risk for MACEs (p = 0.002) and lethal outcomes (p = 0.002). However, a decrease in MPV or P-LCR did not have prognostic value. A decrease in PDW < 9.9% measured 24 h after clopidogrel treatment in NSTEMI patients has good prognostic value for determining the short-term risks of MACEs, possibly providing a better risk stratification of those patients.
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