Mean platelet volume (MPV) is a hematological index that is routinely measured in clinical settings. Although many studies have been conducted to investigate the prognostic significance of MPV in acute coronary syndromes (ACS), the findings have been inconsistent. The goal of this study was to systematically review all current evidence on the association between admission MPV and clinical outcomes after ACS. PubMed, Scopus, Web of Science, and other databases were searched. The primary endpoints were major adverse cardiovascular events (MACE) and mortality. We applied a Knapp and Hartung adjustment, prediction interval calculations and permutation tests during pairwise meta-analyses. A one-stage dose–response meta-analysis was also conducted. The meta-analysis consisted of 41 studies with 33443 participants. Mean platelet volume, as a continuous variable, was associated with the risk of long-term mortality (hazard ratio 1.33, 95% CI 1.19–1.48). After conducting permutation tests and calculation of prediction intervals, this association remained significant. The results for MACE were nonsignificant. Linear models were the best fitted models during dose–response meta-analyses, trends for nonlinearity were significant for long-term endpoints. Admission MPV was associated with long-term mortality in ACS patients, with nonlinear associations between MPV levels and long-term clinical outcomes.
RothGAMensahGAJohnsonCO, et al.Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol2020;76:2982-3021.
2.
KornilukAKoper-LenkiewiczOMKamińskaJ. Mean platelet volume (MPV): new perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediators Inflamm2019;2019:9213074.
3.
MartinJFKristensenSDMathurAGroveELChoudryFA. The causal role of megakaryocyte-platelet hyperactivity in acute coronary syndromes. Nat Rev Cardiol2012;9:658-70.
4.
ChuSGBeckerRCBergerPB, et al.Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemostasis2010;8:148-56.
5.
Pabón OsunaPNieto BallesterosFMoríñigo MuñozJL, et al.[The effect of the mean platelet volume on the short-term prognosis of acute myocardial infarct]. Rev Española Cardiol1998;51:816-22.
6.
ChenXSShaoMZhangT, et al.Prognostic value of elevated mean platelet volume in acute myocardial infarction: a meta-analysis including 8,945 patients. Int J Clin Exp Med2019;12:10151-63.
7.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ2021;372:n71.
8.
RileyRDMoonsKGMSnellKIE, et al.A guide to systematic review and meta-analysis of prognostic factor studies. BMJ2019;364:k4597.
9.
GramesEMStillmanANTingleyMWElphickCS. An automated approach to identifying search terms for systematic reviews using keyword co-occurrence networks. Meth Ecol Evol2019;10:1645-54.
10.
JanssensACJWGwinnMBrockmanJEPowellKGoodmanM. Novel citation-based search method for scientific literature: a validation study. BMC Med Res Methodol2020;20:25.
11.
HaddawayNRPageMJPritchardCCMcGuinnessLA. PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. medRxiv 2021.07.14.21260492.
12.
OuzzaniMHammadyHFedorowiczZElmagarmidA. Rayyan-a web and mobile app for systematic reviews. Syst Rev2016;5:210.
13.
MoonsKGde GrootJABouwmeesterW, et al.Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS checklist. PLoS Medicine2014; 11: e1001744.
WanXWangWLiuJTongT. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol2014;14:135.
16.
HaydenJAvan der WindtDACartwrightJLCôtéPBombardierC. Assessing bias in studies of prognostic factors. Ann Intern Med2013;158:280-6.
17.
HartungJKnappG. A refined method for the meta-analysis of controlled clinical trials with binary outcome. Stat Med2001;20:3875-89.
18.
VeronikiAAJacksonDBenderR, et al.Methods to calculate uncertainty in the estimated overall effect size from a random-effects meta-analysis. Res Synth Methods2019;10:23-43.
19.
LanganDHigginsJPTJacksonD, et al.A comparison of heterogeneity variance estimators in simulated random-effects meta-analyses. Res Synth Methods2019;10:83-98.
20.
RileyRDEliaEGMalinGHemmingKPriceMP. Multivariate meta-analysis of prognostic factor studies with multiple cut-points and/or methods of measurement. Stat Med2015;34:2481-96.
21.
HigginsJPTThompsonSGSpiegelhalterDJ. A re-evaluation of random-effects meta-analysis. J Roy Stat Soc2009;172:137-59.
22.
FollmannDAProschanMA. Valid inference in random effects meta-analysis. Biometrics1999;55:732-37.
23.
CrippaADiscacciatiABottaiMSpiegelmanDOrsiniN. One-stage dose-response meta-analysis for aggregated data. Stat Methods Med Res2019;28:1579-96.
24.
CrippaAOrsiniN. Multivariate dose-response meta-analysis: the dosresmeta R package. J Stat Software2016;72:1-15.
25.
ViechtbauerW. Conducting meta-analyses in R with the metafor Package. J Stat Software2010; 36: 1-48.
R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, 2020, https://www.R-project.org/.
28.
HuczekZKochmanJFilipiakKJ, et al.Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol2005;46:284-90.
29.
Estévez-LoureiroRSalgado-FernándezJMarzoa-RivasR, et al.Mean platelet volume predicts patency of the infarct-related artery before mechanical reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Thromb Res2009;124:536-40.
30.
VakiliHKowsariRNamaziMH, et al.Could mean platelet volume predicts impaired reperfusion and in-hospital major adverse cardiovascular event in patients with primary percutaneous coronary intervention after ST-elevation myocardial in. J Tehran Univ Heart Cent2009; 1: 17-23.
31.
AkpekMKayaMGUyarelH, et al.The association of serum uric acid levels on coronary flow in patients with STEMI undergoing primary PCI. Atherosclerosis2011;219:334-41.
32.
GoncalvesSCLabinazMLe MayM, et al.Usefulness of mean platelet volume as a biomarker for long-term outcomes after percutaneous coronary intervention. Am J Cardiol2011;107:204-09.
33.
TaglieriNSaiaFRapezziC, et al.Prognostic significance of mean platelet volume on admission in an unselected cohort of patients with non ST-segment elevation acute coronary syndrome. Thromb Haemostasis2011;106:132-40.
34.
TekbasEKaraAFAriturkZ, et al.Mean platelet volume in predicting short- and long-term morbidity and mortality in patients with or without ST-segment elevation myocardial infarction. Scand J Clin Lab Investig2011;71:613-19.
35.
DoganAAksoyFIcliA, et al.Mean platelet volume is associated with culprit lesion severity and cardiac events in acute coronary syndromes without ST elevation. Blood Coagul Fibrinolysis2012;23:324-30.
36.
López-CuencaAATello-MontoliuARoldánVPérez-BerbelPValdésMMarínF. Prognostic value of mean platelet volume in patients with non-ST-elevation acute coronary syndrome. Angiology2012;63:241-4.
37.
VrsalovicMPintaricHBabicZ, et al.Impact of admission anemia, C-reactive protein and mean platelet volume on short term mortality in patients with acute ST-elevation myocardial infarction treated with primary angioplasty. Clin Biochem2012;45:1506-9.
38.
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;25:322-27.
39.
AkgulOUyarelHPusurogluH, et al.Prognostic value of elevated mean platelet volume in patients undergoing primary angioplasty for ST-elevation myocardial infarction. Acta Cardiol2013;68:307-14.
40.
EisenABentalTAssaliAKornowskiRLevEI. Mean platelet volume as a predictor for long-term outcome after percutaneous coronary intervention. J Thromb Thrombolysis2013;36:469-74.
41.
Fabregat-AndrésÓCubillosAFerrando-BeltránM, et al.Mean platelet volume is associated with infarct size and microvascular obstruction estimated by cardiac magnetic resonance in ST segment elevation myocardial infarction. Blood Coagul Fibrinolysis2013;24:424-7.
42.
BergoliLCCCastanhoESGonçalvesSC, et al.Volume plaquetário médio como preditor de desfechos cardiovasculares maiores e fluxo coronariano final em pacientes submetidos à intervenção coronária percutânea primária. Rev Bras Cardiol Invasiva2014;22:240-4.
43.
LekstonAHudzikBHawranekM, et al.Prognostic significance of mean platelet volume in diabetic patients with ST-elevation myocardial infarction. J Diabetes Complicat2014;28:652-7.
44.
LiuQWangTChenR, et al.Mean platelet volume predicts left descending artery occlusion in patients with non-ST-elevation myocardial infarction. Platelets2014;25:246-51.
45.
WanZ-FZhouDXueJ-H, et al.Combination of mean platelet volume and the GRACE risk score better predicts future cardiovascular events in patients with acute coronary syndrome. Platelets2014;25:447-51.
46.
GhaffariSPourafkariLJavadzadeganHMasoumiNJafarabadiMANaderND. Mean platelet volume is a predictor of ST resolution following thrombolysis in acute ST elevation myocardial infarction. Thromb Res2015;136:101-6.
47.
LaiH-MXuRYangY-N, et al.Association of mean platelet volume with angiographic thrombus burden and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cathet Cardiovasc Interv2015;85:724-33.
48.
LaiH-MChenQ-JYangY-N, et al.Association of mean platelet volume with impaired myocardial reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Blood Coagul Fibrinolysis2016;27:5-12.
49.
RanjithMPDivyaRajRMathewDGeorgeBKrishnanMN. Mean platelet volume and cardiovascular outcomes in acute myocardial infarction. Heart Asia2016;8:16-20.
50.
SunX-p.LiB-y.LiJZhuW-wHuaQ. Impact of mean platelet volume on long-term mortality in chinese patients with st-elevation myocardial infarction. Sci Rep2016;6:21350.
51.
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;27:452-8.
52.
YuTDongYSunZSunZ. Comparison of prognostic significance of mean platelet volume/platelet count with GRACE for long-term prognosis in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Int J Cardiol2017;228:335-40.
53.
GinaYSungYJPhilCS, et al.Usefulness of serial measurement of the platelet volume indices to predict 30-day mortality in patients with ST segment elevation myocardial infarction. J Korean Soc Emerg Med2017;28:514-25.
54.
AdamAMAliMAShahAA, et al.Efficacy of hematological and coagulation parameters in the diagnosis and prognosis of patients with acute coronary syndrome. Journal Tehran Heart Center2018;13:115-25.
55.
MachadoGPAraujoGNDCarpesCK, et al.Comparison of neutrophil-to-lymphocyte ratio and mean platelet volume in the prediction of adverse events after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. Atherosclerosis2018;274:212-17.
56.
Monteiro JúniorJGMTorresDOCDa SilvaMCFC, et al.Prognostic value of hematological parameters in patients with acute myocardial infarction: Intrahospital outcomes. PLoS One2018; 13: e0194897.
57.
NiuXLiuGHuoL, et al.Risk stratification based on components of the complete blood count in patients with acute coronary syndrome: a classification and regression tree analysis. Sci Rep2018;8:2838.
58.
TianCSongJHeDWuJSunZSunZ. Predictive value of mean platelet volume/platelet count for prognosis in acute myocardial infarction. Int Heart J2018;59:286-92.
59.
ChangHYHsuLWLeeCH, et al.Impact of platelet volume on the clinical outcomes of patients with acute coronary syndrome. Acta Cardiol Sin2019;35:563-70.
60.
GarloboDLNDopicoRRRiveroBSLombilloCRPRodríguezLOCGómezOM. Mean platelet volume and possible prognostic value in patients with acute myocardial infarction. Rev Cubana Med Mil2019;48:696-706.
61.
Chirino NavartaDMonterosATrejoG, et al.Mean platelet volume as prognostic marker in patients with acute coronary syndrome. Rev Argent Cardiol2015;83:292-8.
62.
ÇangaYEmreAKarataşMB, et al.Mean platelet volume predicts short-term prognosis in young patients with st-segment elevation myocardial infarction. J Cardiovasc Emergencies2019;5:50-8.
63.
NiuXYangCZhangYZhangHYaoY. Mean platelet volume on admission improves risk prediction in patients with acute coronary syndromes. Angiology2015;66:456-63.
64.
NozariYParsaMJalaliA, et al.Mean platelet volume and major adverse cardiac events following percutaneous coronary intervention. Arch Iran Med2019;22:198-203.
65.
ŞatıroğluÖDurakoğlugilMEUyduHA, et al.The relationship between mean platelet volume and in-hospital mortality in geriatric patients with ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention. Cardiovasc Innov Appl2019; 4: 135-41.
66.
VogiatzisISamarasAGrigoriadisSSdogkosEKoutsampasopoulosKBostanitisI. The mean platelet volume in the prognosis of coronary artery disease severity and risk stratification of acute coronary syndromes. Med Arch2019;73:76.
67.
ChenXHuangZLiG. Predictive value of neutrophil-to-lymphocyte ratio combined with mean platelet volume for nosocomial major adverse cardiovascular events in patients with acute STEMI after PCI. Chin Gen Pract2020;23:1117-26.
68.
Chirino NavartaDTrejoGLeonardiM, et al.Association between mean platelet volume and resistance to aspirin and P2Y12 receptor inhibitors in elderly patients with acute coronary syndrome. Rev Argent Cardiol2019;87:258-64.
69.
JagroopIATsiaraSMikhailidisDP. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets2003;14:335-6.
70.
PafiliKPenlioglouTMikhailidisDPPapanasN. Mean platelet volume and coronary artery disease. Curr Opin Cardiol2019;34:390-8.
71.
TierneyJFStewartLAGhersiDBurdettSSydesMR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials2007;8:16.
72.
IntHoutJIoannidisJPBormGF. The hartung-knapp-sidik-jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol2014; 14: 25.
73.
JacksonDBowdenJBakerR. How does the DerSimonian and Laird procedure for random effects meta-analysis compare with its more efficient but harder to compute counterparts?J Stat Plann Inference2010;140:961-70.
74.
ColletJPThieleHBarbatoE, et al.2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J2021;42:1289-367.
75.
RoeMTHalabiARMehtaRH, et al.Documented traditional cardiovascular risk factors and mortality in non-st-segment elevation myocardial infarction. Am Heart J2007;153:507-14.
76.
FigtreeGAVernonSTHadziosmanovicN, et al.Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of swedeheart registry data. Lancet2021;397:1085-94.
77.
Garcia-GarciaHMMcFaddenEPFarbA, et al.Standardized end point definitions for coronary intervention trials: the academic research consortium-2 consensus document. Circulation2018;137:2635-50.
78.
AkyüzAAkkoyunDÇDeğirmenciHOranM. Rosuvastatin decreases mean platelet volume in patients with diabetes mellitus. Angiology2016;67:116-20.
79.
PapanasNMaltezosE. Rosuvastatin and mean platelet volume in diabetes. Angiology2016;67:113-5.
80.
LeeJ-BKimG-SChoH-N. Statin and ezetimibe combination therapy decreases mean platelet volume compared to statin monotherapy. J Stroke2017;19:109-10.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
