Association of Platelet Parameters in Acute Coronary Syndrome before and after Anti-platelet Therapy

A.N Nashim Ahmed,Choudhury Meshkat Ahmed,Debatosh Paul,Mosharaf Hossain,Silpi Pervin,Tuhin Sultana

doi:10.3329/bmrcb.v43i2.35181

Abstract

Identification of risk factors for acute coronary syndrome (ACS) is important for both diagnostic and prognostic purposes. Among the platelet parameters- mean platelet volume (MPV) and platelet distribution width (PDW) are thought to be risk factors of ACS. This quasi- experimental study was conducted from September 2011 to August 2012 in the Department of Clinical Pathology, in collaboration with Departments of Cardiology, Bangbandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) . It was enrolled 79 patients with ACS, diagnosed based on clinical history, electrocardiographic changes and increased cardiac markers especially troponin I, and 63 subjects were enrolled as control. For determination of platelet parameters, the blood samples were obtained from all patients of ACS before anti-platelet therapy when patient attended in the cardiac emergency and after 5th day of ongoing anti-platelet therapy; and from control group on the 1st day and 5th day at outpatient department. The blood samples were taken properly and processed in haematology autoanalyser. In this study, the baseline characteristics of study patients were measured. Platelet counts were 273.1±50.15 x 109/L in patients with ACS and 290.78±74.86 x 109/L in control subjects in 1st sample and 284.56±41.93 x 109/L in patients with ACS in 2nd sample. In 1st samples, platelet counts were slightly low in patients with ACS compared to controls and 2nd samples. There were no statistical significant differences between the groups and the samples. MPV was 12.48±1.17 fl and 10.45±0.66 fl in patients with ACS and controls and 11.55±1.08 fl in 2nd sample in ACS cases. PDW was 16.23±2.56 fl, 11.89±1.42 fl and 14.29±2.11 fl in patients with ACS, controls and 2nd sample of ACS cases respectively. Both MPV and PDW were statistically significant between the groups and the samples (p<0.001). The sensitivity, specificity, positive and negative predictive value of platelet parameters of ACS cases were obtained from ROC curve and compared with controls. The best cut off value of platelet count, MPV and PDW were >225 x 109/L, > 10.7 fl and >12.7 fl respectively. The sensitivity, specificity, accuracy, positive and negative predictive value of platelet counts, MPV and PDW were 83%, 28.1%, 42.3%, 37.6%, 64%; 90.6%, 49.4%, 64.8%, 51.6%, 89.8%; and 94.3%,52.8%, 69%,54.9%, 94.1% respectively. The study showed that PDW had higher sensitivity and specificity in contrast to MPV. Platelet parameters were increased in patients with ACS before anti-platelet therapy and gradually decreased after anti-platelet therapy. These two markers may used as predictor for early detection of ACS and risk stratification, when other cardiac biomarkers are negative.

Highlights

Acute coronary syndrome (ACS) is a medical emergency and requires immediate hospital admission
Varol et al and Yilmaz et al found that mean platelet volume (MPV) was significantly higher in patients with ACS groups than controls, along with reverse changes in platelet count. 14,15 Similar findings were to be found study done by Pizzuli et al and Mercan et al 16,5 They found platelet counts were significantly lower in the ACS groups as compared to control subjects, but MPV was significantly higher in ACS
Chu et al found that MPV was associated with patients AMI and described MPV as a risk factor and prognostic indicator in cardiovascular disease

Summary

Introduction

Acute coronary syndrome (ACS) is a medical emergency and requires immediate hospital admission. ACS is the most prevalent cardiac disorder.[1] It is a major cause of death and disability. The incidence of ACS is increasing day by day, because modification of life style and habit. There are many factors to develop ACS Without modification of these factors or improvement in primary prevention and treatment, ACS remains the chief causes of death in most developed countries.[2] Diseases of the coronary arteries are almost always due to atheroma and its complications, thrombosis. The culprit lesion is usually a complex ulcerated or fissured atheromatous plaque with adherent platelet-rich thrombus and local coronary artery spasm. The thrombus may undergo spontaneous lyses over the course of the few days, by this time irreversible myocardial damage might occur. Most patients present when it is still possible to salvage myocardium and improve out.[3]

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