Abstract 12102: Use of Mean Platelet Volume to Predict Significant Coronary Artery Disease in Patients With Non-ST Elevation Acute Coronary Syndromes

Abstract

Background: Acute coronary syndrome (ACS) is characterized by unstable plaque and thrombotic process involving central role of platelets (PLT). Significant number of patients undergoing cardiac catheterization with non-STE ACS have non-significant coronary artery disease (CAD). It is postulated that an increase in Mean platelet volume (MPV) signifies an increase in inflammation during ACS, and thus, a higher risk of significant CAD. Method: This retrospective study enrolled patients with non-STE ACS who underwent coronary angiography from two teaching hospitals from 2011 to 2016. Significant CAD was defined >70% stenosis in at least one coronary artery. Exclusion criteria included patients with known CAD, hematologic disease, and on anticoagulant medication. Hematologic and angiographic data were collected by independent observers. Results: A total of 213 patients were enrolled (male 53%, mean age 61± 12.3). Mean MPV level was 8.9 fl and 45% of patients had significant CAD. When comparing patients with high MPV (MPV>=9 fl) vs low MPV (MPV<9 fl), high MPV group had significantly more significant CAD (55% vs 35% p =0.005) and higher HbA1c (6.9 vs 6.4 p =0.02). Both groups had similar DM, HTN, smoking, and obesity rates. Patients with significant CAD had high MPV level (9.2± 1.07 fl vs 8.6 ± 1.03 fl p =0.001), high MPV/PLT (0.46 vs 0.40 p =0.01), older age (64.5±11 vs 59.2 ± 12 p =0.02), low HDL level (42±12 vs 47 ±16 p =0.01), and non-significantly low PLT count (219 vs 230 p =0.2). Multivariate analysis showed that increased age (AOR 1.04 95% CI 1.01-1.07, p =0.002), high MPV (AOR 1.46, 95% CI 1.01-1.076, p =0.01), high troponin (AOR 3.01, 95% CI 1.40-6.46, p =0.005), and low HDL levels (AOR 0.96, 95% CI 0.94-0.99, p =0.005) were associated with significant CAD. High MPV along with high troponin level was associated with a 4.8-fold increased risk for significant CAD as compared with normal MPV with high troponin (OR 4.8, 95% CI 1.31-17.6, p =0.001). Conclusion: Non-STE ACS patients with high MPV had significantly more significant CAD. Adding high MPV level to troponin level increased the predictive value of significant CAD. This result may help determine who would benefit from cardiac catheterization. This finding needs to be further validated in larger, prospective studies.