Our study aimed to investigate the association between platelet indices and their in-hospital change and long-term prognosis in acute coronary syndrome (ACS). Data from a randomized controlled trial (NCT02927808) recruiting ACS patients were analyzed (survival analysis). The examined variables were platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) on admission and discharge, as well as their alteration during hospitalization. The primary endpoint was major adverse cardiac events (MACE) (cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke or hospitalization for unstable angina) and all-cause mortality, while secondary endpoints were all-cause hospitalization and bleeding events. The study included 252 patients with a follow-up of 39 (28–45) months. In the univariate analysis, MACE was associated with discharge PC [hazard ratio (HR) 2.20, 95% confidence interval (CI) 1.10–4.40], discharge MPV (HR 0.48, 95% CI 0.25–0.94), and in-hospital PC difference (HR 0.25, 95% CI 0.13–0.51). In the multivariable analysis, only in-hospital PC decrease correlated with lower MACE incidence (adjusted HR .27, 95% CI 0.14–0.54) and lower all-cause hospitalization risk (adjusted HR 0.36, 95% CI 0.19–0.68). PC reduction during hospitalization for ACS is an independent predictor of better prognosis.
CreaFLibbyP. Acute coronary syndromes: the way forward from mechanisms to precision treatment. Circulation2017; 136: 1155–1166.
2.
SibbingDAngiolilloDJHuberK. Antithrombotic therapy for acute coronary syndrome: past, present and future. Thromb Haemost2017; 117: 1240–1248.
3.
ThomasMRStoreyRF. Effect of P2Y12 inhibitors on inflammation and immunity. Thromb Haemost2015; 114: 490–497.
4.
KornilukAKoper-LenkiewiczOMKamińskaJKemonaHDymicka-PiekarskaV. Mean Platelet Volume (MPV): new perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediat Inflamm2019; 2019: 1–14.
5.
BudzianowskiJPieszkoKBurchardtPRzeźniczakJHiczkiewiczJ. The role of hematological indices in patients with acute coronary syndrome. Dis Markers2017; 2017: 3041565.
6.
MałyszczakAŁukawskaADylagILisWMysiakAKuliczkowskiW. Blood platelet count at hospital admission impacts long-term mortality in patients with acute coronary syndrome. Cardiol2020; 145: 148–154.
7.
BudzianowskiJPieszkoKBurchardtPRzeźniczakJHiczkiewiczJ. The role of hematological indices in patients with acute coronary syndrome. Dis Markers2017; 2017: 3041565.
8.
EisenABentalTAssaliAKornowskiRLevEI. Mean platelet volume as a predictor for long-term outcome after percutaneous coronary intervention. J Thromb Thrombolysis2013; 36: 469–474.
9.
ChoiS-WChoiD-HKimH-WKuY-HHaS-IParkG. Clinical outcome prediction from mean platelet volume in patients undergoing percutaneous coronary intervention in Korean cohort: implications of more simple and useful test than platelet function testing. Platelets2014; 25: 322–327.
10.
NiuXYangCZhangYZhangHYaoY. Mean platelet volume on admission improves risk prediction in patients with acute coronary syndromes. Angiology2015; 66: 456–463.
11.
UlucanŞKeserAKayaZ, et al. Association between PDW and long term major adverse cardiac events in patients with acute coronary syndrome. Heart Lung Circ2016; 25: 29–34.
12.
TimóteoATPapoilaALLousinhaA, et al. Predictive impact on mediumterm mortality of hematological parameters in Acute Coronary Syndromes: added value on top of GRACE risk score. Eur Heart J: Acute Cardiovascular Care2015; 4: 172–179.
13.
WasilewskiJDesperakPHawranekM, et al. Prognostic implications of mean platelet volume on short- and long-term outcomes among patients with non-ST-segment elevation myocardial infarction treated with percutaneous coronary intervention: A single-center large observational study. Platelets2016; 27: 452–458.
14.
BolatIAkgulOCakmakHA, et al. The prognostic value of admission mean platelet volume to platelet count ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Kardiol Pol2016; 74: 346–355.
15.
GiustinoGKirtaneAJGénéreuxP, et al. Relation between platelet count and platelet reactivity to thrombotic and bleeding risk: from the assessment of dual antiplatelet therapy with drug-eluting stents study. Am J Cardiol2016; 117: 1703–1713.
16.
LyHQKirtaneAJMurphySA, et al. Association of platelet counts on presentation and clinical outcomes in ST-elevation myocardial infarction (from the TIMI Trials). Am J Cardiol2006; 98: 1–5.
17.
NikolskyEGrinesCLCoxDA, et al. Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC Trial). Am J Cardiol2007; 99: 1055–1061.
18.
SongPSAhnKTJeongJO, et al. Association of baseline platelet count with all-cause mortality after acute myocardial infarction. Eur Heart J. Acute Cardiovasc Care2020; Online ahead of print: 2048872620925257.
19.
OikonomouEKRepanasTIPapanastasiouC, et al. The effect of in-hospital acquired thrombocytopenia on the outcome of patients with acute coronary syndromes: a systematic review and meta-analysis. Thromb Res2016; 147: 64–71.
20.
BoulmpouAKartasAFarmakisI, et al. Motivational interviewing to support LDL-C therapeutic goals and lipid-lowering therapy compliance in patients with acute coronary syndromes (IDEAL-LDL) study: rationale and design. Hellenic J Cardiol2019; 60: 249–253.
21.
FarmakisIZafeiropoulosSKartasA, et al. Treatment practices and lipid profile of patients with acute coronary syndrome: results from a tertiary care hospital. Acta Cardiol2020; 75: 527–534.
22.
LancéMD. Mean platelet volume needs standardisation. Thromb Haemostasis2015; 113: 908.
23.
ThygesenKAlpertJSJaffeAS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol2018; 72: 2231–2264.
24.
HicksKATchengJEBozkurtB, et al. 2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials: a report of the American College of Cardiology/American Heart Association Task Force on clinical data standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards). Circulation 20142015; 132: 302–361.
25.
GibsonCMMegaJLBurtonP, et al. Rationale and design of the Anti-Xa therapy to lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome-thrombolysis in myocardial infarction 51 (ATLAS-ACS 2 TIMI 51) trial: a randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of rivaroxaban in subjects with acute coronary syndrome. Am Heart J2011; 161: 815–821.
26.
TurnerSJKetchTRGandhiSKSaneDC. Routine hematologic clinical tests as prognostic markers in patients with acute coronary syndromes. Am Heart J2008; 155: 806–816.
27.
TurakhiaMPMurphySAPintoTL, et al. Association of platelet count with residual thrombus in the myocardial infarct-related coronary artery among patients treated with fibrinolytic therapy for ST-segment elevation acute myocardial infarction. Am J Cardiol2004; 94: 1406–1410.
28.
Von HundelshausenPWeberC. Platelets as immune cells: Bridging inflammation and cardiovascular disease. Circ Res2007; 100: 27–40.
29.
GasparyanAYAyvazyanLMukanovaUYessirkepovMKitasGD. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med2019; 39: 345–357.
30.
LeeSHizohIKovacsA, et al. Predictors of high on-clopidogrel platelet reactivity in patients with acute coronary syndrome. Platelets2016; 27: 159–167.
31.
RayKKCannonCP. Pathological changes in acute coronary syndromes: the role of statin therapy in the modulation of inflammation, endothelial function and coagulation. J Thromb Thrombolysis2004; 18: 89–101.
32.
EPILOG Investigators. Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med1997; 336: 1689–1696.
33.
VonderheideRHThadhaniRKuterDJ. Association of thrombocytopenia with the use of intra-aortic balloon pumps. Am J Med1998; 105: 27–32.
34.
De LucaGSantagostinoMSeccoGG, et al. Mean platelet volume and the extent of coronary artery disease: results from a large prospective study. Atherosclerosis2009; 206: 292–297.
35.
TaskesenTSekhonHWroblewskiI, et al. Usefulness of mean platelet volume to predict significant coronary artery disease in patients with non-ST-elevation acute coronary syndromes. Am J Cardiol2017; 119: 192–196.
36.
BeyanCKaptanKIfranA. Platelet count, mean platelet volume, platelet distribution width, and plateletcrit do not correlate with optical platelet aggegation responses in healthy volunteers. J Thromb Thrombolysis2006; 22: 161–164.
37.
LiSLiuHLiuJ. Predictive performance of adding platelet reactivity on top of CRUSADE score for 1-year bleeding risk in patients with acute coronary syndrome. J Thromb Thrombolysis2016; 42: 360–368.
38.
IsmailNJordanKPKadamUTEdwardsJJKinnairdTMamasMA. Bleeding after hospital discharge following acute coronary syndrome: incidence, types, timing, and predictors. J Am Heart Ass2019; 8: e013679.
39.
AltmanDGRoystonP. The cost of dichotomising continuous variables. BMJ (Clinical Research Ed.)2006; 332: 1080.
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