Mean Platelet Volume as a Predictor of Impaired Reperfusion in Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Khaled Magdy Saad Elsayed


Abstract


Introduction Primary percutaneous coronary intervention (PCI) has been established as the gold standard in the management of patients presenting with ST-elevated myocardial infarction (STEMI) Although primary PCI is successful most of the times, incomplete myocardial reperfusion is noted in a number of procedures despite the reopening of the occluded Infarct related artery. Hence, the concept of No-reflow phenomenon emerges; defined as restoration of the epicardial blood flow without restoration of the flow to the microcirculation (17–19). No-reflow phenomenon should never be underestimated, as it has a strong association with increased in-hospital mortality, malignant arrhythmias, cardiac failure, and a poor long-term prognosis due to post-procedural MI or extension of MI (17–19). Platelets play a serious role in the pathogenesis of No-reflow phenomenon. Platelets make aggregates that plug capillaries and eventually obstructing the blood flow (46, 47). Mean platelet volume (MPV); a measure of the platelet size, has been showed to correlate with platelets’ reactivity (1) Aim of the work We sought to determine the prognostic value of mean platelet volume (MPV) for angiographic reperfusion in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Patients and methods The study was done on eighty patients admitted to Ain Shams university hospitals and Nasr city health insurance hospital, with the diagnosis of acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) in the period between January 2016 and May 2016. Complete history taking and through physical examination were done. Blood samples were drawn on admission. MPV and routine investigations analysis was done as appropriate. Primary PCI was performed for each patient and angiograms were analyzed with respect to post-interventional flow at the IRA. Transthoracic echocardiography was done afterwards to assess the left ventricular functional outcome. Patients were followed up until discharge for any MACCEs. Results No reflow determined by TIMI flow grade and MBG PPCI was significantly higher (47.06%) in the high MPV group (p-value = 0.009). No reflow incidence in the low MPV group was (19.57%) MPV of >10.6 predicted incidence of no- reflow with a sensitivity of 52% and specificity of 83.6% This study came out with two major concepts with respect to patients who presented with STEMI and underwent Primary PCI 1. The MPV value on admission was significantly higher in post-intervention impaired reperfusion group 2. MPV is a potential preprocedural independent predictor of no-reflow in patients with STEMI undergoing primary PCI


Other data

Other Titles متوسط حجم الصفائح الدمويه كمتوقع لضعف اعادة اشباع الخلايا في احتشاء عضلة القلب الحاد المعالج برأب الوعاء التاجي الابتدائي
Issue Date 2016
URI http://research.asu.edu.eg/handle/12345678/2653


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