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