Maden Orhan, Kacmaz Fehmi, Selcuk Mehmet T, Selcuk Hatice, Metin Fatma, Tufekcioglu Omac, Atak Ramazan, Balbay Yucel, Ilkay Erdogan
Cardiology Department, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Coron Artery Dis. 2007 Dec;18(8):639-44. doi: 10.1097/MCA.0b013e3282f0eecb.
Mean platelet volume (MPV), a marker for platelet reactivity, and white blood cell count (WBC-C), a marker for inflammation, have been shown to be predictive of unfavourable outcomes among survivors of ST elevation myocardial infarction (STEMI). The relationship of admission MPV and WBC-C with infarct-related artery (IRA) patency is not clear. We aimed to evaluate the value of admission MPV and WBC-C for the prediction of IRA patency, in patients with acute STEMI treated with primary percutaneous coronary intervention.
Blood samples were obtained on admission in 351 STEMI patients. The patients who had thrombolysis in myocardial infarction (TIMI) 3 flow in initial angiography constituted the IRA patent group and others having less than TIMI 3 flow constituted the IRA occluded group.
In 16% of the patients, IRAs were found to be patent on initial angiography. Patients in the IRA occluded group had higher admission MPVs (9.3+/-1.2 vs. 8.6+/-1.3 fl, P<0.001) and higher WBC-C (13.3+/-4.8 vs. 11.0+/-2.9, P=0.002) compared with patients in the patent IRA group. In regression analysis, WBC-Cs [beta, 0.131; odds ratio (OR), 1.140; 95% confidence interval (CI), 1.043-1.245, P=0.004)] and MPV (beta, 0.519; OR, 1.680; 95% CI, 1.206-2.339, P=0.002) were found to be independent predictors of occluded IRA. The best cutoff value of MPV for predicting an occluded IRA was determined to be 8.55 fl with a sensitivity of 74% and a specificity of 60%.
MPV and WBC-C at admission might be valuable in the prediction of IRA patency and in planning the need for adjunctive therapy to improve outcomes in patients with STEMI undergoing percutaneous coronary intervention.
血小板平均体积（MPV）是血小板反应性的标志物，白细胞计数（WBC-C）是炎症的标志物，已被证明可预测ST段抬高型心肌梗死（STEMI）幸存者的不良预后。入院时MPV和WBC-C与梗死相关动脉（IRA）通畅情况的关系尚不清楚。我们旨在评估入院时MPV和WBC-C对接受直接经皮冠状动脉介入治疗的急性STEMI患者IRA通畅情况的预测价值。
对351例STEMI患者入院时采集血样。初始血管造影显示心肌梗死溶栓（TIMI）血流3级的患者构成IRA通畅组，其他TIMI血流小于3级的患者构成IRA闭塞组。
16%的患者在初始血管造影时发现IRA通畅。与IRA通畅组患者相比，IRA闭塞组患者入院时的MPV更高（9.3±1.2 vs. 8.6±1.3 fl，P<0.001），WBC-C也更高（13.3±4.8 vs. 11.0±2.9，P=0.002）。在回归分析中，发现WBC-C [β，0.131；比值比（OR），1.140；95%置信区间（CI），1.043-1.245，P=0.004]和MPV（β，0.519；OR，1.680；95%CI，1.206-2.339，P=0.002）是IRA闭塞的独立预测因素。预测IRA闭塞的MPV最佳截断值确定为8.55 fl，敏感性为74%，特异性为60%。
入院时的MPV和WBC-C可能有助于预测IRA通畅情况，并为接受经皮冠状动脉介入治疗的STEMI患者制定辅助治疗需求以改善预后提供参考。
