Volume Plaquetário Médio Como Preditor de Desfechos Cardiovasculares Maiores e Fluxo Coronariano Final em Pacientes Submetidos à Intervenção Coronária Percutânea Primária

Abstract

background:Platelets play a key role in the pathophysiology of acute myocardial infarction. There is evidence that higher platelet volumes may have increased prothrombotic potential. The aim of this study was to evaluate whether mean platelet volume can predict culprit coronary vessel flow and adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods: Primary endpoint was the composite of adverse cardiovascular events (death, stroke, myocardial infarction, stent thrombosis, class-III or IV angina and heart failure) at 30 days. The secondary endpoint was evaluated by the angiographic TIMI flow grade after the procedure. results: Of the 215 patients included in the primary percutaneous coronary intervention registry, 168 (78.6%) had their mean platelet volume calculated before the procedure and were analyzed in the present study. Mean platelet volume values were stratified in tertiles, and a high value was considered as > 11 femtoliters (fL). Mean platelet volume > 11 fL was an independent predictor of cardiovascular events at 30 days (p = 0.02). It was observed that patients with final TIMI flow grade zero or 1 showed a trend towards higher mean platelet volume compared with those with final TIMI flow 2 or 3 (11.3 ± 0.9 fL vs. 10.5 ± 1.3 fL; p = 0.06). Conclusions: Baseline mean platelet volume is a simple, useful, and easy to measure marker to predict the risk of cardiovascular events at 30 days in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Future studies may answer whether more aggressive antithrombotic therapy results in better angiographic and/or clinical outcomes in patients with larger and more active platelets.

The prognostic value of mean platelet volume in patients with coronary artery disease: a systematic review with meta-analyses

“…5,8,9,29,30,33,35,38,40,41,45,52,53,56,59,60,67 Four studies were classified as low-risk in four out of six domains, 5,6,46,62 meanwhile a total of 18 studies only showed low-risk qualities in one domain. 31,32,34,36,[41][42][43]49,50,52,59,63,66,[69][70][71][72]75 The review discovered significant flaws in some included studies. Concerns concerning bias arose from unclear participant selection processes, high dropout rates, and incomplete data reporting.…”

The Prognostic Utility of Mean Platelet Volume in Patients With Acute Coronary Syndrome: A Systematic Review With Meta-Analyses

“…In short, within the study participation domain, some studies did not clearly specify sampling procedures (eg, consecutive or random); hence, they were labeled as of high risk. 30,37,42,43,48,50,64,66 Regarding study attrition, the majority of investigations did not report the percentage of population who dropped out during follow-up. 29,32,[34][35][36][37][38][39][40][41]43,46,52,54,61,62 Other studies did not attempt to compare lost to follow up patients with those who completed the study.…”

“…The risk of bias due to prognostic factor measurement was regarded as high in studies that did not describe vendors of hematological analyzers. 42,46,66 As preanalytical factors can impact on MPV values, we collected data on used anticoagulants, time between venepuncture and MPV measurement, and resolution of analyzers. 69,70 None of the included studies specified the resolution of the analyzers.…”

“…Study confounding was also flawed in many investigations since there was no adjustment for traditional risk factors. 35,[37][38][39][40]42,44,46,[54][55][56]61,62,65,66,68 In terms of selective reporting, 2 studies determined MACE as a study endpoint in the Methods, but provided mortality data in the Results. 39,43 Because to our knowledge, none of the investigations were prospectively registered, selective reporting was difficult to determine.…”