Elsevier

Atherosclerosis

Volume 277, October 2018, Pages 108-112
Atherosclerosis

Mean platelet volume and long-term cardiovascular outcomes in patients with stable coronary artery disease

https://doi.org/10.1016/j.atherosclerosis.2018.08.048Get rights and content

Highlights

  • This study aimed to evaluate the impact of mean platelet volume (MPV) in patients following elective percutaneous coronary intervention (PCI).

  • Patients with low MPV values showed higher incidences of cardiovascular events.

  • A decrease in MPV was significantly associated with poor clinical outcomes.

  • The results were contrary to the report from previous studies on acute coronary syndrome (ACS) patients.

Abstract

Background and aims

Although an elevated mean platelet volume (MPV) has been associated with poor clinical outcomes after acute coronary syndrome (ACS), the association between MPV and long-term outcomes in patients with stable coronary artery disease (CAD) remains uncertain. We aimed to investigate the impact of pre-procedural MPV levels in patients following elective percutaneous coronary intervention (PCI).

Methods

We studied 2872 stable CAD patients who underwent their first PCI and who had available data on pre-procedural MPV between 2002 and 2016. Patients were divided into quartiles based on their MPV. The incidences of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, were evaluated.

Results

The median MPV was 10.4 fL (interquartile range: 9.8–11.0). During a median follow-up of 5.6 years, 498 (17.3%) MACE were identified, with a cumulative incidence significantly higher in the lowest MPV group than in other groups (p < 0.01). After adjustment for platelet count and the other cardiovascular risk factors, the lowest MPV group had a significantly higher risk of MACE compared with the highest MPV groups (hazard ratio: 1.43, 95% confidence interval 1.10–1.86, p = 0.009). Decreasing MPV as a continuous variable was associated with the incidence of MACE (hazard ratio: 1.16 per 1 fL decrease, 95% confidence interval 1.04–1.30, p = 0.007).

Conclusions

Contrary to previous studies on ACS patients, this study showed that a low MPV was associated with worse clinical outcomes among stable CAD patients.

Introduction

Cardiovascular disease is one of the leading causes of mortality and disability, and remains a major concern despite improved clinical outcomes with evidence-based treatment [1]. Therefore, identification of the residual risk for cardiovascular disease is essential for more effective management and prevention.

Platelets are essential for primary hemostasis and repair of the endothelium, but they also play a key role in the pathogenesis of atherosclerosis and arterial thrombosis [2,3]. Mean platelet volume (MPV) is a major parameter of platelet size that is routinely determined by complete blood count analyzers at a relatively low cost. Compared with smaller platelets, larger platelets are more readily stimulated to release chemical mediators and are recognized as being more active and likely to aggregate [4]. Increased MPV levels have been reported to be associated with coronary artery disease (CAD), peripheral arterial disease, and cerebrovascular disease [[5], [6], [7]]. In addition, the correlation between a high MPV and poor clinical outcomes after myocardial infarction (MI) has been previously demonstrated [8,9]. However, the association between MPV levels and clinical outcomes in patients with stable CAD remains uncertain. Therefore, in the present study, we aimed to investigate the impact of pre-procedural MPV levels in stable CAD patients after elective percutaneous coronary intervention (PCI).

Section snippets

Patients and data collection

In this observational study, the data of consecutive patients, who underwent their first-time elective PCI at Juntendo University from January 2002 to December 2016, were analyzed. Patients missing MPV values and those with known malignancy or active inflammatory disease were excluded from the study. Patients were divided into 4 groups according to MPV values (<9.8, 9.8–10.3, 10.4–10.9 and 10.9<).

The demographic data and information on coronary risk factors, medications,

Baseline and procedural characteristics

Of the 2882 patients who underwent elective PCI, pre-procedural MPV values were available for 2872 patients (99.7%). The median and mean MPV values were 10.4 fL (IQR, 9.8–11.0 fL) and 10.5 ± 0.9 fL, respectively. The clinical and procedural characteristics of these patients are shown in Table 1. Patients in the lowest MPV group were significantly older and had lower baseline hemoglobin, higher platelet count, and higher concentration of high-sensitivity C-reactive protein (hs-CRP); whereas

Discussion

In the present study, the association between pre-procedural MPV level and long-term cardiovascular outcomes in patients with stable CAD was examined. The major findings of the present report were as follows: (1) patients with low MPV were old but had lower prevalence of diabetes mellitus and increased HDL-C levels; (2) compared with patients with high MPV values, those with low MPV values showed significantly higher incidences of MACE, all-cause death, and MI; and (3) a decrease in MPV was

Conflicts of interest

The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

Author contributions

H. Wada, T. Dohi and K. Miyauchi interpreted the data and drafted the manuscript. H. Wada, T. Dohi, J. Shitara, H. Endo, S. Suwa and H. Daida conceived and designed the research. S. Doi, S. Tsuboi, M. Ogita, H. Iwata, S. Okazaki and K. Isoda acquired and analyzed the data. H. Wada, T. Dohi and T. Kasai made critical revision of the manuscript. All authors revised the manuscripts.

Acknowledgments

The authors are grateful to the staff of the Department of Cardiovascular Medicine at Juntendo University. The authors also wish to express their appreciation for the secretarial assistance of Yumi Nozawa.

References (40)

Cited by (32)

  • Prevalence and prognostic factors for aortic dilatation in giant cell arteritis – a longitudinal study

    2021, Seminars in Arthritis and Rheumatism
    Citation Excerpt :

    Parameters of endothelial dysfunction are key contributors to atherosclerotic-related AA but their association with GCA-related AD is unknown [18–22]. Among laboratory biomarkers, inflammation based-ratios, including high neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), fibrinogen-albumin-ratio (FAR) and C-reactive protein (CRP)-albumin-ratio (CRPAR), low lymphocyte-monocyte ratio (LMR), and mean platelet volume (MPV) as well as altered lymphocyte subsets have thoroughly been investigated in cardiovascular diseases and were associated with poor cardiovascular outcomes and higher rates of cardiovascular events [23–28]. However, their role as a predictor for AD in GCA remains unclear.

View all citing articles on Scopus
View full text