Does mean platelet volume and platelet distribution width predict inadequate myocardial reperfision in primary percutaneous coronary intervention?

Abstract

Backround: We sought to determine if Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) as markers of platelet activation are associated with inadequate Myocardial Reperfusion (MR) at microvasculature level and adverse clinical events 30 days after Primary Percutaneous Coronary Intervention (pPCI). Methods: Study included 209 consecutive STEMI patients in whom pPCI was done within 12h from the symptom onset from July 2012th to January 2013th. The manual thrombus aspiration was done in 106 (50.7%) patients. Inadequate MR was define as absence of angiographic (final TIMI flow ≤ 3 or final TIMI 3 flow with MBG 0 or 1) and/or ECG (ST resolution < 70% at ECG done 30-60 minutes after the end of procedure) signs of reperfusion. Venous peripheral blood samples were drawn at hospital admission. MACE were defined as composite of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or new or worsening NYHA Class IV heart failure at 30 days. Results: Inadequate MR had 110 (51.4%) patients. Two groups had comparable demographic, clinical and procedural caracteristics exept higher age (62.4 vs. 57.1 year, p<0.001), less frequent use of manual thrombus aspiration (43.4% vs. 56.6%, p=0.017) and higher baseline creatinin level (87.0 vs 77.4 μmol/L, p=0.013) at inadequate MR group. Two groups had comparable MPV values while there were statistical higher PDW values in the inadequate MR group (16.32 vs. 16.04, p=0.039). The higher PDW values has observed in the subgroup of patients which had pPCI without manual aspiration thrombectomy (16.39 vs. 15.8, p=0.044), but this statistical difference had not observed in pPCI patients with manual aspiration thrombectomy (16.24 vs. 16.18, p=0.664). By the binary logistic regression as a predictor of inadequate MR is calculated age (p=0.021), and cratinine baseline levels (p=0.045) and there is a trend for manual aspiration thrombectomy (p=0.068). MACE rate at 30 days in inadequate MR group was 5 (5.0%) vs. 2 (2.2%) in the group of patients with adequate MR, (p=0.281). Conclusion: In addition to age and impaired renal function higher baseline PDW values could predict inadequate reperfusion on microvasculature level after primary percutaneous intervention.