J Cardiovasc Transl Res. 2021 Dec;14(6):1093-1103. doi: 10.1007/s12265-021-10113-z. Epub 2021 Mar 01.

Mean Platelet Volume/Platelet Count Ratio and Culprit Plaque Morphologies: An Optical Coherence Tomography Study in Patients with ST Segment Elevation Myocardial Infarction.

Journal of cardiovascular translational research

Li Song, Run-Zhen Chen, Xiao-Xiao Zhao, Zhao-Xue Sheng, Peng Zhou, Chen Liu, Jian-Nan Li, Jin-Ying Zhou, Ying Wang, Han-Jun Zhao, Hong-Bing Yan

PMID: 33649987 DOI: 10.1007/s12265-021-10113-z

Abstract

This study aimed to investigate the predictive value of mean platelet volume/platelet count ratio (MPR) for coronary plaque features in patients with ST segment elevation myocardial infarction (STEMI). A total of 275 STEMI patients undergoing preintervention optical coherence tomography examination were included, with 142 categorized as plaque rupture (PR) and 133 as plaque erosion (PE). Multivariable logistic regression showed higher MPR was an independent predictor of PR (tertile 3 vs tertile 1, odds ratio: 6.257, 95% confidence interval: 1.586-24.686, P = 0.009). MPR showed better diagnostic performance than other platelet indices. The optimal MPR threshold for diagnosing PR was 0.0473 (sensitivity: 0.721, specificity: 0.647). When added to models of established risk factors, MPR significantly improved the predictive accuracy of PR (area under the curve: 0.767 vs 0.722, P

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.

Keywords: Plaque rupture; ST segment elevation myocardial infarction; mean platelet volume/platelet count ratio

References

1. Higuma, T., Soeda, T., Abe, N., Yamada, M., Yokoyama, H., Shibutani, S., et al. (2015). A combined optical coherence tomography and intravascular ultrasound study on plaque rupture, plaque erosion, and calcified nodule in patients with ST segment elevation myocardial infarction: incidence, morphologic characteristics, and outcomes after percutaneous coronary intervention. JACC. Cardiovascular Interventions, 8(9), 1166–1176. https://doi.org/10.1016/j.jcin.2015.02.026 . - PubMed
2. Crea, F., & Libby, P. (2017). Acute coronary syndromes. Circulation, 136(12), 1155–1166. https://doi.org/10.1161/circulationaha.117.029870 . - PubMed
3. Jia, H., Dai, J., Hou, J., Xing, L., Ma, L., Liu, H., et al. (2017). Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study). European Heart Journal, 38(11), 792–800. https://doi.org/10.1093/eurheartj/ehw381 . - PubMed
4. Prati, F., Uemura, S., Souteyrand, G., Virmani, R., Motreff, P., Di Vito, L., et al. (2013). OCT-based diagnosis and management of STEMI associated with intact fibrous cap. JACC: Cardiovascular Imaging, 6(3), 283–287. https://doi.org/10.1016/j.jcmg.2012.12.007 . - PubMed
5. Hu, S., Wang, C., Zhe, C., Zhu, Y., Yonetsu, T., Jia, H., et al. (2017). Plaque erosion delays vascular healing after drug eluting stent implantation in patients with acute coronary syndrome: an in vivo optical coherence tomography study. Catheterization and Cardiovascular Interventions, 89(S1), 592–600. https://doi.org/10.1002/ccd.26943 . - PubMed
6. Jang, I. K., Tearney, G. J., MacNeill, B., Takano, M., Moselewski, F., Iftima, N., et al. (2005). In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation, 111(12), 1551–1555. https://doi.org/10.1161/01.CIR.0000159354.43778.69 . - PubMed
7. Jia, H., Abtahian, F., Aguirre, A. D., Lee, S., Chia, S., Lowe, H., et al. (2013). In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography. Journal of the American College of Cardiology, 62(19), 1748–1758. https://doi.org/10.1016/j.jacc.2013.05.071 . - PubMed
8. Badimón, L., Vilahur, G., & Padró, T. (2009). Lipoproteins, platelets and atherothrombosis. Revista Española de Cardiología, 62(10), 1161–1178. https://doi.org/10.1016/s1885-5857(09)73331-6 . - PubMed
9. Badimon, L., Padro, T., & Vilahur, G. (2012). Atherosclerosis, platelets and thrombosis in acute ischaemic heart disease. European Heart Journal Acute Cardiovascular Care, 1(1), 60–74. https://doi.org/10.1177/2048872612441582 . - PubMed
10. Guenancia, C., Hachet, O., Stamboul, K., Bejot, Y., Leclercq, T., Garnier, F., et al. (2017). Incremental predictive value of mean platelet volume/platelet count ratio in in-hospital stroke after acute myocardial infarction. Platelets, 28(1), 54–59. https://doi.org/10.1080/09537104.2016.1203397 . - PubMed
11. Azab, B., Torbey, E., Singh, J., Akerman, M., Khoueiry, G., McGinn, J. T., et al. (2011). Mean platelet volume/platelet count ratio as a predictor of long-term mortality after non-ST-elevation myocardial infarction. Platelets, 22(8), 557–566. https://doi.org/10.3109/09537104.2011.584086 . - PubMed
12. Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., et al. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST segment elevation of the European Society of Cardiology (ESC). European Heart Journal, 39(2), 119–177. https://doi.org/10.1093/eurheartj/ehx393 . - PubMed
13. Tearney, G. J., Regar, E., Akasaka, T., Adriaenssens, T., Barlis, P., Bezerra, H. G., et al. (2012). Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. Journal of the American College of Cardiology, 59(12), 1058–1072. https://doi.org/10.1016/j.jacc.2011.09.079 . - PubMed
14. Partida, R. A., Libby, P., Crea, F., & Jang, I. K. (2018). Plaque erosion: a new in vivo diagnosis and a potential major shift in the management of patients with acute coronary syndromes. European Heart Journal, 39(22), 2070–2076. https://doi.org/10.1093/eurheartj/ehx786 . - PubMed
15. Dai, J., Xing, L., Jia, H., Zhu, Y., Zhang, S., Hu, S., et al. (2018). In vivo predictors of plaque erosion in patients with ST segment elevation myocardial infarction: a clinical, angiographical, and intravascular optical coherence tomography study. European Heart Journal, 39(22), 2077–2085. https://doi.org/10.1093/eurheartj/ehy101 . - PubMed
16. Steyerberg, E. W., Harrell Jr., F. E., Borsboom, G. J., Eijkemans, M. J., Vergouwe, Y., & Habbema, J. D. (2001). Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. Journal of Clinical Epidemiology, 54(8), 774–781. https://doi.org/10.1016/s0895-4356(01)00341-9 . - PubMed
17. Slavka, G., Perkmann, T., Haslacher, H., Greisenegger, S., Marsik, C., Wagner, O. F., et al. (2011). Mean platelet volume may represent a predictive parameter for overall vascular mortality and ischemic heart disease. Arteriosclerosis, Thrombosis, and Vascular Biology, 31(5), 1215–1218. https://doi.org/10.1161/ATVBAHA.110.221788 . - PubMed
18. Martin, J. F., Bath, P. M., & Burr, M. L. (1991). Influence of platelet size on outcome after myocardial infarction. Lancet, 338(8780), 1409–1411. https://doi.org/10.1016/0140-6736(91)92719-i . - PubMed
19. Huczek, Z., Kochman, J., Filipiak, K. J., Horszczaruk, G. J., Grabowski, M., Piatkowski, R., et al. (2005). Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. Journal of the American College of Cardiology, 46(2), 284–290. https://doi.org/10.1016/j.jacc.2005.03.065 . - PubMed
20. Bekler, A., Ozkan, M. T., Tenekecioglu, E., Gazi, E., Yener, A. U., Temiz, A., et al. (2015). Increased Platelet distribution width is associated with severity of coronary artery disease in patients with acute coronary syndrome. Angiology, 66(7), 638–643. https://doi.org/10.1177/0003319714545779 . - PubMed
21. Wang, J., Li, X., Pu, J., Jin, S., Jia, L., Li, X., et al. (2019). Mean platelet volume and coronary plaque vulnerability: an optical coherence tomography study in patients with non-ST-elevation acute coronary syndrome. BMC Cardiovascular Disorders, 19(1), 128. https://doi.org/10.1186/s12872-019-1115-2 . - PubMed
22. Mueller, C., Neumann, F. J., Hochholzer, W., Trenk, D., Zeller, T., Perruchoud, A. P., et al. (2006). The impact of platelet count on mortality in unstable angina/non-ST segment elevation myocardial infarction. American Heart Journal, 151(6), 1214 e1211-1217. https://doi.org/10.1016/j.ahj.2006.03.011 . - PubMed
23. Nikolsky, E., Grines, C. L., Cox, D. A., Garcia, E., Tcheng, J. E., Sadeghi, M., et al. (2007). Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). The American Journal of Cardiology, 99(8), 1055–1061. https://doi.org/10.1016/j.amjcard.2006.11.066 . - PubMed
24. Kastrati, A., Schömig, A., Schulz, S., Bruskina, O., Mehilli, J., Ndrepepa, G., et al. (2017). Relationship between platelet count and 30-day clinical outcomes after percutaneous coronary interventions. Thrombosis and Haemostasis, 98(10), 852–857. https://doi.org/10.1160/th07-04-0285 . - PubMed
25. Gawaz, M., Langer, H., & May, A. E. (2005). Platelets in inflammation and atherogenesis. The Journal of Clinical Investigation, 115(12), 3378–3384. https://doi.org/10.1172/JCI27196 . - PubMed
26. Ranjith, M. P., Divya, R., Mehta, V. K., Krishnan, M. G., KamalRaj, R., & Kavishwar, A. (2009). Significance of platelet volume indices and platelet count in ischaemic heart disease. Journal of Clinical Pathology, 62(9), 830–833. https://doi.org/10.1136/jcp.2009.066787 . - PubMed
27. Fernández-Ortiz, A., Badimon, J. J., Falk, E., Fuster, V., Meyer, B., Mailhac, A., et al. (1994). Characterization of the relative thrombogenicity of atherosclerotic plaque components: implications for consequences of plaque rupture. Journal of the American College of Cardiology, 23(7), 1562–1569. https://doi.org/10.1016/0735-1097(94)90657-2 . - PubMed
28. Falk, E., Nakano, M., Bentzon, J. F., Finn, A. V., & Virmani, R. (2013). Update on acute coronary syndromes: the pathologists' view. European Heart Journal, 34(10), 719–728. https://doi.org/10.1093/eurheartj/ehs411 . - PubMed
29. Burke, A. P., Farb, A., Malcom, G. T., Liang, Y., Smialek, J., & Virmani, R. (1998). Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women. Circulation, 97(21), 2110–2116. https://doi.org/10.1161/01.cir.97.21.2110 . - PubMed
30. Kramer, M. C., Rittersma, S. Z., de Winter, R. J., Ladich, E. R., Fowler, D. R., Liang, Y. H., et al. (2010). Relationship of thrombus healing to underlying plaque morphology in sudden coronary death. Journal of the American College of Cardiology, 55(2), 122–132. https://doi.org/10.1016/j.jacc.2009.09.007 . - PubMed
31. Niccoli, G., Montone, R. A., Di Vito, L., Gramegna, M., Refaat, H., Scalone, G., et al. (2015). Plaque rupture and intact fibrous cap assessed by optical coherence tomography portend different outcomes in patients with acute coronary syndrome. European Heart Journal, 36(22), 1377–1384. https://doi.org/10.1093/eurheartj/ehv029 . - PubMed
32. Yu, T., Dong, Y., Sun, Z., & Sun, Z. (2017). 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. International Journal of Cardiology, 228, 335–340. https://doi.org/10.1016/j.ijcard.2016.11.082 . - PubMed

Publication Types

• Journal Article

Grant support

• 2016-I2M-1-009/Chinese Academy of Medical Sciences
• 81970308/National Natural Science Foundation of China