Key result
High platelet indices independently predicted in-hospital major cardiovascular events in STEMI patients post-primary PCI, increasing the risk with an adjusted HR of 38.13.
Why the study?
High mortality in STEMI is driven by in-hospital MACE, prompting evaluation of platelet indices and intracoronary thrombus grade as risk predictors after primary PCI.
Do high platelet indices and high intracoronary thrombus grade predict in-hospital MACE in patients with STEMI post-primary PCI?
Cohort (n=71)
No
Do high platelet indices and high intracoronary thrombus grade predict in-hospital MACE in patients with STEMI post-primary PCI?
Hazard Ratio: 38.13 (95% CI 5.16–282.03)
Absolute Event Rate: 89.1% vs 4%
p-value: p=<0.001
High platelet indices (PDW and MPV) and high intracoronary thrombus grade are strong, independent predictors of in-hospital MACE in STEMI patients undergoing primary PCI, demonstrating high predictive ability when combined.
May aid in-hospital risk stratification after primary PCI in STEMI; hypothesis-generating and requires prospective validation before clinical use.
Background: The high mortality rate of ST Elevation Myocardial Infarction (STEMI) is caused by its complications, especially in-hospital major cardiovascular events (MACE). This study aims to determine the relationship between platelet indices and intracoronary thrombus grade as predictors of in-hospital MACE and the interaction of the combination of both predictors in patients with STEMI post-primary percutaneous coronary intervention (PCI). Methods: This prospective cohort study was conducted with STEMI patients who underwent primary PCI. Data was analyzed by SPSS 24.0.0.0 version. Results: There were 71 samples: 46 patients (64.8%) with a high platelet index and 48 patients (67.6%) with a high intracoronary thrombus grade. During in-hospital follow-up, there were found that 42 patients (59.2%) experienced MACE. The cut-off value used classifies high platelet index for PDW 11.25 fl (AUC 0.892; CI 95% 0.786-0.999; p<0.001) and MPV 10.15 (AUC 0.901; CI 95% 0.812-0.990; p<0.001). The Cox regression backward log-rank model showed both high platelet indices (adjusted HR 38.13; CI 95% 5.16-282.03; p<0.001) and high Intracoronary Thrombus Grade (adjusted HR 31.67; CI 95% 4.28-234.54; p=0.001) played an independent role as predictors of MACE during hospitalization, regardless of the influence of coronary angiography results, Killip class, smoking and consumption of acetosal and clopidogrel. The combination of two predictors of high platelet indices and high Intracoronary Thrombus Grade based on SEM analysis showed that 95.2% experienced in-hospital MACE (Mantel-Haenzel Common Estimate 17.48; Breslow-Day Homogeneity p=0.772; Cochran’s and Mantel-Haenszel p=<0.001), had better predictive ability as seen from the comparison of the respective AUC values, namely the combination, high platelet indices and high Intracoronary Thrombus Grade (0.942; 0.902; 0.873; p<0.001). Conclusion: High platelet indices and high intracoronary thrombus grade can be used as additional information for risk stratification of in-hospital MACE of STEMI patients post-primary PCI, especially when both variables were combined.
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Gunawan et al. (2023) conducted a cohort in ST Elevation Myocardial Infarction (STEMI) (n=71). High platelet indices (PDW ≥11.25 fl or MPV ≥10.15 fl) vs. Non-high platelet indices was evaluated on In-hospital Major Cardiovascular Events (MACE) (adjusted HR 38.13, 95% CI 5.16-282.03, p=<0.001). High platelet indices independently predicted in-hospital major cardiovascular events in STEMI patients post-primary PCI, increasing the risk with an adjusted HR of 38.13.
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