Adam Arsalan Majeed, Ali Muhammad Armughan, Shah Arshad Ali, Rizvi Ather Hasan, Rehan Aiman, Godil Ansab, Abbas Abdul Haseeb, Durrani Najam Ul Ain, Shaikh Ali Tariq, Mallick Muhammad Saad Ali, Lashari Muhammad Nawaz
Dow University of Health Sciences (DUHS), Karachi, Pakistan.
Cardiology Department, Civil Hospital, Karachi, Pakistan.
J Tehran Heart Cent. 2018 Jul;13(3):115-125.
The diagnosis and management of acute coronary syndrome (ACS) have improved significantly over the past few decades; however, the recognition of myocardial ischemia still proves to be a dilemma for cardiologists. The aim of this study was to determine the role of hematological and coagulation parameters in the diagnosis and prognosis of patients with ACS. This prospective study recruited 250 patients with ACS and 250 healthy controls. The diagnostic role of hematological and coagulation parameters was assessed by comparing the patients with ACS with the control group. The relationships between these parameters and mortality were determined by dividing the patients into 2 groups: Group A (discharged) and Group B (patients who died within 30 days of follow-up). Multivariate Cox regression analysis was performed to calculate the hazard ratio (HR). The mean age of the patients was 55.14±10.71 years, and 65.2% of them were male. Prothrombin time (P<0.001), activated partial thromboplastin time (P<0.001), mean platelet volume (MPV) (P<0.001), white blood cell (WBC) count (P<0.001), and red blood cell distribution width (RDW) (P<0.001) were significantly higher in the case group than in the control group. WBC count (P<0.001), RDW (P<0.001), and MPV (P<0.001) were significantly higher in the controls than in the case group. The Cox regression model showed that RDW above 16.55% (HR=6.8), MPV greater than 11.25 fL (HR=2.6), and WBC higher than 10.55×10/μL (HR=6.3) were the independent predictors of mortality. : In addition to being the independent predictors of short-term mortality, RDW, WBC, and MPV when used together with the coagulation profile may aid in the diagnosis of ACS in patients presenting with chest pain.
在过去几十年中，急性冠状动脉综合征（ACS）的诊断和管理有了显著改善；然而，心肌缺血的识别对心脏病专家来说仍然是一个难题。本研究的目的是确定血液学和凝血参数在ACS患者诊断和预后中的作用。这项前瞻性研究招募了250例ACS患者和250例健康对照者。通过将ACS患者与对照组进行比较，评估血液学和凝血参数的诊断作用。通过将患者分为两组：A组（出院）和B组（随访30天内死亡的患者），确定这些参数与死亡率之间的关系。进行多变量Cox回归分析以计算风险比（HR）。患者的平均年龄为55.14±10.71岁，其中65.2%为男性。病例组的凝血酶原时间（P<0.001）、活化部分凝血活酶时间（P<0.001）、平均血小板体积（MPV）（P<0.001）、白细胞（WBC）计数（P<0.001）和红细胞分布宽度（RDW）（P<0.001）显著高于对照组。对照组的WBC计数（P<0.001）、RDW（P<0.001）和MPV（P<0.001）显著高于病例组。Cox回归模型显示，RDW高于16.55%（HR=6.8）、MPV大于11.25 fL（HR=2.6）和WBC高于10.55×10/μL（HR=6.3）是死亡率的独立预测因素。此外，除了作为短期死亡率的独立预测因素外，RDW、WBC和MPV与凝血指标一起使用时，可能有助于诊断胸痛患者的ACS。
