Abstract
Background: The Primary Percutaneous Coronary Intervention (PPCI) is the preferred therapeutic strategy for patients who experienced ST-Elevation Myocardial Infarction (STEMI).
Objective: We aimed to evaluate the association of hematological indices, including hemoglobin level, platelets, White Blood Cells (WBCs) count, and MPV before PPCI with the TIMI grade flow after PPCI.
Methods: STEMI patients who experienced PPCI were included in the present retrospective crosssectional study. Then participants were divided into three groups based on their post-procedural TIMI flow grades. Demographic data and hematologic indices of patients before PPCI were collected and their association with the TIMI grade flow after PPCI was evaluated. To compare the quantitative and qualitative variables, chi-square and t-tests were performed, respectively.
Results: We found that elevated levels of hemoglobin and decreased levels of MPV had a significant association with an advanced grade of TIMI flow. Interestingly, in the normal range, there was a significant association between higher platelet count and TIMI-flow grade 1. Besides, TIMI flow grades 2 and 3 had a significant association with low and moderate platelets count, respectively.
Conclusion: In conclusion, evaluating MPV, platelets, and hemoglobin levels before PPCI as easy and accessible parameters may be able to identify high-risk STEMI patients undergoing PPCI.
Keywords: STEMI, TIMI-flow grade, PPCI, prognosis, adverse outcome, hematologic indices.
Graphical Abstract
[1]
O’Gara, P.T.; Kushner, F.G.; Ascheim, D.D.; Casey, D.E., Jr; Chung, M.K.; de Lemos, J.A.; Ettinger, S.M.; Fang, J.C.; Fesmire, F.M.; Franklin, B.A.; Granger, C.B.; Krumholz, H.M.; Linderbaum, J.A.; Morrow, D.A.; Newby, L.K.; Ornato, J.P.; Ou, N.; Radford, M.J.; Tamis-Holland, J.E.; Tommaso, C.L.; Tracy, C.M.; Woo, Y.J.; Zhao, D.X. 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Catheter. Cardiovasc. Interv., 2013, 82(1), E1-E27.
[http://dx.doi.org/10.1002/ccd.24776] [PMID: 23299937]
[http://dx.doi.org/10.1002/ccd.24776] [PMID: 23299937]
[2]
Trost, J.C.; Lange, R.A. Treatment of acute coronary syndrome. Crit. Care Med., 2012, 40(6), 1939-1945.
[http://dx.doi.org/10.1097/CCM.0b013e31824e18c2] [PMID: 22610195]
[http://dx.doi.org/10.1097/CCM.0b013e31824e18c2] [PMID: 22610195]
[3]
Vogel, B.; Claessen, B.E.; Arnold, S.V.; Chan, D.; Cohen, D.J.; Giannitsis, E.; Gibson, C.M.; Goto, S.; Katus, H.A.; Kerneis, M.; Kimura, T.; Kunadian, V.; Pinto, D.S.; Shiomi, H.; Spertus, J.A.; Steg, P.G.; Mehran, R. ST-segment elevation myocardial infarction. Nat. Rev. Dis. Primers, 2019, 5(1), 39.
[http://dx.doi.org/10.1038/s41572-019-0090-3] [PMID: 31171787]
[http://dx.doi.org/10.1038/s41572-019-0090-3] [PMID: 31171787]
[4]
Lacey, B.; Herrington, W.G.; Preiss, D.; Lewington, S.; Armitage, J. The role of emerging risk factors in cardiovascular outcomes. Curr. Atheroscler. Rep., 2017, 19(6), 28.
[http://dx.doi.org/10.1007/s11883-017-0661-2] [PMID: 28477314]
[http://dx.doi.org/10.1007/s11883-017-0661-2] [PMID: 28477314]
[5]
Piepoli, M.F.; Hoes, A.W.; Agewall, S.; Albus, C.; Brotons, C.; Catapano, A.L.; Cooney, M.T.; Corrà, U.; Cosyns, B.; Deaton, C.; Graham, I.; Hall, M.S.; Hobbs, F.D.R.; Løchen, M.L.; Löllgen, H.; Marques-Vidal, P.; Perk, J.; Prescott, E.; Redon, J.; Richter, D.J.; Sattar, N.; Smulders, Y.; Tiberi, M.; van der Worp, H.B.; van Dis, I.; Verschuren, W.M.M.; Binno, S. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart J., 2016, 37(29), 2315-2381.
[http://dx.doi.org/10.1093/eurheartj/ehw106] [PMID: 27222591]
[http://dx.doi.org/10.1093/eurheartj/ehw106] [PMID: 27222591]
[6]
Gao, N.; Qi, X.; Dang, Y.; Li, Y.; Wang, G.; Liu, X.; Zhu, N.; Fu, J. Establishment and validation of a risk model for prediction of in-hospital mortality in patients with acute ST-elevation myocardial infarction after primary PCI. BMC Cardiovasc. Disord., 2020, 20(1), 513.
[http://dx.doi.org/10.1186/s12872-020-01804-7] [PMID: 33297955]
[http://dx.doi.org/10.1186/s12872-020-01804-7] [PMID: 33297955]
[7]
Giglioli, C.; Tujjar, O.; Cecchi, E.; Landi, D.; Chiostri, M.; Valente, S.; Baldereschi, G.J.; Meucci, F.; Gensini, G.F.; Romano, S.M. Hemodynamic changes acutely determined by primary PCI in STEMI patients evaluated with a minimally invasive method. World J. Cardiovasc. Dis., 2013, 3(4), 69-72.
[http://dx.doi.org/10.4236/wjcd.2013.34A010]
[http://dx.doi.org/10.4236/wjcd.2013.34A010]
[8]
Keeley, E.C.; Boura, J.A.; Grines, C.L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review of 23 randomised trials. Lancet, 2003, 361(9351), 13-20.
[http://dx.doi.org/10.1016/S0140-6736(03)12113-7] [PMID: 12517460]
[http://dx.doi.org/10.1016/S0140-6736(03)12113-7] [PMID: 12517460]
[9]
Mehta, R.H.; Ou, F.S.; Peterson, E.D.; Shaw, R.E.; Hillegass, W.B., Jr; Rumsfeld, J.S.; Roe, M.T. Clinical significance of post-procedural TIMI flow in patients with cardiogenic shock undergoing primary percutaneous coronary intervention. JACC Cardiovasc. Interv., 2009, 2(1), 56-64.
[http://dx.doi.org/10.1016/j.jcin.2008.10.006] [PMID: 19463399]
[http://dx.doi.org/10.1016/j.jcin.2008.10.006] [PMID: 19463399]
[10]
Fuster, V.; Fallon, J.T.; Badimon, J.J.; Nemerson, Y. The unstable atherosclerotic plaque: Clinical significance and therapeutic intervention. Thromb. Haemost., 1997, 78(1), 247-255.
[http://dx.doi.org/10.1055/s-0038-1657534] [PMID: 9198161]
[http://dx.doi.org/10.1055/s-0038-1657534] [PMID: 9198161]
[11]
Smith, E.B.; Keen, G.A.; Grant, A.; Stirk, C. Fate of fibrinogen in human arterial intima. Arteriosclerosis, 1990, 10(2), 263-275.
[http://dx.doi.org/10.1161/01.ATV.10.2.263] [PMID: 2317160]
[http://dx.doi.org/10.1161/01.ATV.10.2.263] [PMID: 2317160]
[12]
Kamińska, J.; Koper, O.M.; Siedlecka-Czykier, E.; Matowicka-Karna, J.; Bychowski, J.; Kemona, H. The utility of inflammation and platelet biomarkers in patients with acute coronary syndromes. Saudi J. Biol. Sci., 2018, 25(7), 1263-1271.
[http://dx.doi.org/10.1016/j.sjbs.2016.10.015] [PMID: 30505168]
[http://dx.doi.org/10.1016/j.sjbs.2016.10.015] [PMID: 30505168]
[13]
David Bessman, J.; Williams, L.J.; Ridgway Gilmer, P., Jr Mean platelet volume. The inverse relation of platelet size and count in normal subjects, and an artifact of other particles. Am. J. Clin. Pathol., 1981, 76(3), 289-293.
[http://dx.doi.org/10.1093/ajcp/76.3.289] [PMID: 7282629]
[http://dx.doi.org/10.1093/ajcp/76.3.289] [PMID: 7282629]
[14]
Järemo, P.; Hansson, G.; Nilsson, O. Elevated inflammatory parameters are associated with lower platelet density in acute myocardial infarctions with ST-elevation. Thromb. Res., 2000, 100(6), 471-478.
[http://dx.doi.org/10.1016/S0049-3848(00)00366-2] [PMID: 11152926]
[http://dx.doi.org/10.1016/S0049-3848(00)00366-2] [PMID: 11152926]
[15]
Akgul, O.; Uyarel, H.; Pusuroglu, H.; Gul, M.; Isiksacan, N.; Turen, S.; Erturk, M.; Surgit, O.; Cetin, M.; Bulut, U.; Baycan, O.F.; Uslu, N. Prognostic value of elevated mean platelet volume in patients undergoing primary angioplasty for ST-elevation myocardial infarction. Acta Cardiol., 2013, 68(3), 307-314.
[http://dx.doi.org/10.1080/AC.68.3.2983426] [PMID: 23882877]
[http://dx.doi.org/10.1080/AC.68.3.2983426] [PMID: 23882877]
[16]
Choi, S.W.; Choi, D.H.; Kim, H.W.; Ku, Y.H.; Ha, S.I.; Park, G. Clinical outcome prediction from mean platelet volume in patients undergoing percutaneous coronary intervention in Korean cohort: Implications of more simple and useful test than platelet function testing. Platelets, 2014, 25(5), 322-327.
[http://dx.doi.org/10.3109/09537104.2013.821606] [PMID: 23909871]
[http://dx.doi.org/10.3109/09537104.2013.821606] [PMID: 23909871]
[17]
Chung, S.; Song, Y.B.; Hahn, J.Y.; Chang, S.A.; Lee, S.C.; Choe, Y.H.; Choi, S.H.; Choi, J.H.; Lee, S.H.; Oh, J.K.; Gwon, H.C. Impact of white blood cell count on myocardial salvage, infarct size, and clinical outcomes in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: A magnetic resonance imaging study. Int. J. Cardiovasc. Imaging, 2014, 30(1), 129-136.
[http://dx.doi.org/10.1007/s10554-013-0303-x] [PMID: 24104952]
[http://dx.doi.org/10.1007/s10554-013-0303-x] [PMID: 24104952]
[18]
Budzianowski, J.; Pieszko, K.; Burchardt, P.; Rzeźniczak, J.; Hiczkiewicz, J. The role of hematological indices in patients with acute coronary syndrome. Dis. Markers, 2017, 2017, 1-9.
[http://dx.doi.org/10.1155/2017/3041565] [PMID: 29109595]
[http://dx.doi.org/10.1155/2017/3041565] [PMID: 29109595]
[19]
Oylumlu, M.; Yildiz, A.; Oylumlu, M.; Yüksel, M.; Polat, N.; Bilik, M.Z.; Akyüz, A.; Aydin, M.; Acet, H.; Soydinç, S. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anatol. J. Cardiol., 2015, 15(4), 277-283.
[http://dx.doi.org/10.5152/akd.2014.5366] [PMID: 25413224]
[http://dx.doi.org/10.5152/akd.2014.5366] [PMID: 25413224]
[20]
Yaylak, B.; Altıntaş, B.; Özcan, K.S.; Akdeniz, E.; Avcı, İ.; Zeren, G.; Şimşek, B.; Karabay, C.Y. Relation of hemoglobin level to no-reflow in patients with ST-segment elevation myocardial infarction undergoing primary coronary intervention. Postepy Kardiol. Interwencyjnej, 2018, 14(4), 383-390.
[http://dx.doi.org/10.5114/aic.2018.79868] [PMID: 30603028]
[http://dx.doi.org/10.5114/aic.2018.79868] [PMID: 30603028]
[21]
Gibson, C.M.; Cannon, C.P.; Murphy, S.A.; Marble, S.J.; Barron, H.V.; Braunwald, E. Relationship of the TIMI myocardial perfusion grades, flow grades, frame count, and percutaneous coronary intervention to long-term outcomes after thrombolytic administration in acute myocardial infarction. Circulation, 2002, 105(16), 1909-1913.
[http://dx.doi.org/10.1161/01.CIR.0000014683.52177.B5] [PMID: 11997276]
[http://dx.doi.org/10.1161/01.CIR.0000014683.52177.B5] [PMID: 11997276]
[22]
Parhar, K.; Millar, V.; Zochios, V.; Bruton, E.; Jaworksi, C.; West, N.; Vuylsteke, A. Clinical outcomes of patients undergoing primary percutaneous coronary intervention for acute myocardial infarction requiring the intensive care unit. J. Intensive Care, 2018, 6(1), 5.
[http://dx.doi.org/10.1186/s40560-018-0275-y] [PMID: 29416868]
[http://dx.doi.org/10.1186/s40560-018-0275-y] [PMID: 29416868]
[23]
Sen, N.; Afsar, B.; Ozcan, F.; Buyukkaya, E.; Isleyen, A.; Akcay, A.B.; Yuzgecer, H.; Kurt, M.; Karakas, M.F.; Basar, N.; Hajro, E.; Kanbay, M. The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Atherosclerosis, 2013, 228(1), 203-210.
[http://dx.doi.org/10.1016/j.atherosclerosis.2013.02.017] [PMID: 23489347]
[http://dx.doi.org/10.1016/j.atherosclerosis.2013.02.017] [PMID: 23489347]
[24]
Vogt, A.; von Essen, R.; Tebbe, U.; Feuerer, W.; Appel, K.F.; Neuhaus, K.L. Impact of early perfusion status of the infarct-related artery on short-term mortality after thrombolysis for acute myocardial infarction: Retrospective analysis of four german multicenter studies. J. Am. Coll. Cardiol., 1993, 21(6), 1391-1395.
[http://dx.doi.org/10.1016/0735-1097(93)90314-Q] [PMID: 8473646]
[http://dx.doi.org/10.1016/0735-1097(93)90314-Q] [PMID: 8473646]
[25]
Zeren, G.; Avci, I.I.; Şimşek, B.; Sungur, A.; Çınar, T.; Tanik, V.O.; Genç, D.; Çinier, G.; Karabay, C.Y. Post percutaneous coronary intervention hemoglobin levels predict in-hospital mortality in patients with STEMI treated with primary percutaneous coronary intervention. Anatol. J. Cardiol., 2021, 25(9), 623-629.
[http://dx.doi.org/10.5152/AnatolJCardiol.2021.07282] [PMID: 34498593]
[http://dx.doi.org/10.5152/AnatolJCardiol.2021.07282] [PMID: 34498593]
[26]
Meneveau, N.; Schiele, F.; Seronde, M.F.; Descotes-Genon, V.; Oettinger, J.; Chopard, R.; Ecarnot, F.; Bassand, J.P. Anemia for risk assessment of patients with acute coronary syndromes. Am. J. Cardiol., 2009, 103(4), 442-447.
[http://dx.doi.org/10.1016/j.amjcard.2008.10.023] [PMID: 19195499]
[http://dx.doi.org/10.1016/j.amjcard.2008.10.023] [PMID: 19195499]
[27]
Wright, R.S.; Anderson, J.L.; Adams, C.D.; Bridges, C.R.; Casey, D.E., Jr; Ettinger, S.M.; Fesmire, F.M.; Ganiats, T.G.; Jneid, H.; Lincoff, A.M.; Peterson, E.D.; Philippides, G.J.; Theroux, P.; Wenger, N.K.; Zidar, J.P.; Anderson, J.L.; Adams, C.D.; Antman, E.M.; Bridges, C.R.; Califf, R.M.; Casey, D.E., Jr; Chavey, W.E., II; Fesmire, F.M.; Hochman, J.S.; Levin, T.N.; Lincoff, A.M.; Peterson, E.D.; Theroux, P.; Wenger, N.K.; Zidar, J.P. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the management of patients with unstable angina/non-St-elevation myocardial infarction. J. Am. Coll. Cardiol., 2011, 57(19), e215-e367.
[http://dx.doi.org/10.1016/j.jacc.2011.02.011] [PMID: 21545940]
[http://dx.doi.org/10.1016/j.jacc.2011.02.011] [PMID: 21545940]
[28]
Separham, A.; Seyedi, S.; Heidari Sarvestani, A. The relationship between hemoglobin level and no-reflow phenomenon in patients with myocardial infraction undergoing primary PCI. Multidiscipl. Cardiovasc. Ann., 2020, 1(10), e107077.
[29]
Huang, C.H.; Chang, C.C.; Kuo, C.L.; Huang, C.S.; Chiu, T.W.; Lin, C.S.; Liu, C.S. Serum iron concentration, but not hemoglobin, correlates with TIMI risk score and 6-month left ventricular performance after primary angioplasty for acute myocardial infarction. PLoS One, 2014, 9(8), e104495.
[http://dx.doi.org/10.1371/journal.pone.0104495] [PMID: 25100442]
[http://dx.doi.org/10.1371/journal.pone.0104495] [PMID: 25100442]
[30]
Pafili, K.; Penlioglou, T.; Mikhailidis, D.P.; Papanas, N. Mean platelet volume and coronary artery disease. Curr. Opin. Cardiol., 2019, 34(4), 390-398.
[http://dx.doi.org/10.1097/HCO.0000000000000624] [PMID: 30950847]
[http://dx.doi.org/10.1097/HCO.0000000000000624] [PMID: 30950847]
[31]
Celebi, O.O.; Canbay, A.; Celebi, S.; Sahin, D.; Aydoğdu, S.; Diker, E. The effect of admission mean platelet volume on TIMI frame count measured after fibrinolytic therapy in patients with acute ST-segment elevation myocardial infarction. Turk Kardiyol. Dern. Ars., 2009, 37(5), 307-311.
[PMID: 19875902]
[PMID: 19875902]
[32]
Celik, T.; Kaya, M.G.; Akpek, M.; Gunebakmaz, O.; Balta, S.; Sarli, B.; Duran, M.; Demirkol, S.; Uysal, O.K.; Oguzhan, A.; Gibson, C.M. Predictive value of admission platelet volume indices for in-hospital major adverse cardiovascular events in acute ST-segment elevation myocardial infarction. Angiology, 2015, 66(2), 155-162.
[http://dx.doi.org/10.1177/0003319713513493] [PMID: 24301422]
[http://dx.doi.org/10.1177/0003319713513493] [PMID: 24301422]
[33]
Estévez-Loureiro, R.; Salgado-Fernández, J.; Marzoa-Rivas, R.; Barge-Caballero, E.; Pérez-Pérez, A.; Noriega-Concepción, V.; Calviño-Santos, R.; Vázquez-Rodríguez, J.M.; Vázquez-González, N.; Castro-Beiras, A.; Kaski, J.C. Mean platelet volume predicts patency of the infarct-related artery before mechanical reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Thromb. Res., 2009, 124(5), 536-540.
[http://dx.doi.org/10.1016/j.thromres.2009.03.012] [PMID: 19467699]
[http://dx.doi.org/10.1016/j.thromres.2009.03.012] [PMID: 19467699]
[34]
Lekston, A.; Hudzik, B.; Hawranek, M.; Szkodzinski, J.; Gorol, J.; Wilczek, K.; Gasior, M.; Polonski, L. Prognostic significance of mean platelet volume in diabetic patients with ST-elevation myocardial infarction. J. Diabetes Complicat., 2014, 28(5), 652-657.
[http://dx.doi.org/10.1016/j.jdiacomp.2014.05.002] [PMID: 24942286]
[http://dx.doi.org/10.1016/j.jdiacomp.2014.05.002] [PMID: 24942286]
[35]
Ösken, A.; Hacı, R.; Dinç Asarcıklı, L.; Arıkan, M.E.; Onuk, T.; Ünal Dayı, Ş.; Çam, N. Mean platelet volume/platelet count ratio as a predictor of stent thrombosis in patients with ST-segment–elevation myocardial infarction. Ir. J. Med. Sci., 2021, 190(3), 1095-1102.
[http://dx.doi.org/10.1007/s11845-021-02626-y] [PMID: 33893611]
[http://dx.doi.org/10.1007/s11845-021-02626-y] [PMID: 33893611]
[36]
Linden, M.D.; Furman, M.I.; Frelinger, A.L., III; Fox, M.L.; Barnard, M.R.; Li, Y.; Przyklenk, K.; Michelson, A.D. Indices of platelet activation and the stability of coronary artery disease. J. Thromb. Haemost., 2007, 5(4), 761-765.
[http://dx.doi.org/10.1111/j.1538-7836.2007.02462.x] [PMID: 17371489]
[http://dx.doi.org/10.1111/j.1538-7836.2007.02462.x] [PMID: 17371489]
[37]
Nikolsky, E.; Grines, C.L.; Cox, D.A.; Garcia, E.; Tcheng, J.E.; Sadeghi, M.; Mehran, R.; Lansky, A.J.; Na, Y.; Stone, G.W. Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). Am. J. Cardiol., 2007, 99(8), 1055-1061.
[http://dx.doi.org/10.1016/j.amjcard.2006.11.066] [PMID: 17437727]
[http://dx.doi.org/10.1016/j.amjcard.2006.11.066] [PMID: 17437727]
[38]
Regev, A.; Stark, P.; Blickstein, D.; Lahav, M. Thrombotic complications in essential thrombocythemia with relatively low platelet counts. Am. J. Hematol., 1997, 56(3), 168-172.
[http://dx.doi.org/10.1002/(SICI)1096-8652(199711)56:3<168::AID-AJH6>3.0.CO;2-W] [PMID: 9371529]
[http://dx.doi.org/10.1002/(SICI)1096-8652(199711)56:3<168::AID-AJH6>3.0.CO;2-W] [PMID: 9371529]
