Effect of Mean Platelet Volume on Postintervention Coronary Blood Flow in Patients with Chronic Stable Angina Pectoris

WOS: 000207738600007PubMed ID: 18316827Objectives. In our study we sought to determine whether mean platelet volume (MPV), measured on admission, could be used in determining decreased coronary blood flow (CBF) in stable coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). Background. Platelets play a crucial role in the pathophysiology of CAD. MPV reflects platelet function and activity. There are no reports regarding the effect of MPV on CBF in patients with stable CAD undergoing PCI. Methods. A total of 66 consecutive patients (mean age: 58 +/- 5 years, 74% male) with the diagnosis of stable CAD who were hospitalized for PCI were prospectively enrolled in our study. Coronary flow rates of all subjects were documented by corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) for each major coronary artery before and after PCI. Blood samples for MPV estimation, platelet count and other laboratory data obtained on admission were measured on the day of the scheduled PCI. Patients were divided into two groups according to MPV levels measured on admission: 1) high MPV group and 2) normal MPV group. Results. A final TIMI 3 flow was achieved in all patients with no complications. Procedural characteristics of PCI, except left anterior descending artery intervention, were similar in the two groups. Patients with high MPV had significantly higher CTFC than those with a normal MPV (24 +/- 3 vs. 17 +/- 5; p = 0.001). The MPV correlated strongly with post-PCI CTFC (R = 0.625; p = 0.0001). Multiple logistic regression analysis showed that only MPV was an independent predictor of post-PCI CTFC after adjustment for baseline characteristics (OR 1.9, 95% CI 1.2-2.3; p = 0.001). Conclusions. MPV may be considered a useful hematological marker, allowing for early and easy identification of patients with stable CAD who are at a higher risk of post-PCI low-reflow

Prognostic value of the neutrophil-lymphocyte ratio in patients with ST-elevated acute myocardial infarction

© The Author(s) 2012The predictive value of leukocyte counts has been reported in patients with acute myocardial infarction (AMI). We aimed to evaluate the predictive value of the total leukocyte count and neutrophil-lymphocyte (N/L) ratio for mortality due to AMI. A total of 522 patients with acute ST-elevated MI were included in the study. The study population was divided into tertiles based on admission N/L ratio values. High (n = 174) and low N/L (n = 348) ratio groups were defined as patients having values in the third tertile (>5.77) and lower 2 tertiles (≤5.77), respectively. The high N/L ratio group had a significantly higher incidence of in-hospital cardiovascular mortality (13.8% vs 4.6%, P 5.77 was found to be an independent predictor of in-hospital cardiovascular mortality (hazard ratio: 3.78, 95% confidence interval: 1.71-8.30, P = .001). A high N/L ratio is a strong and independent predictor of in-hospital cardiovascular mortality of AMI with ST elevation

Myocardial bridge: a bridge to atherosclerosis

WOS: 000253867900004PubMed ID: 17347068Objective: Myocardial bridge (MB) is a congenital anomaly characterized by narrowing during systole of some of the epicardial coronary arterial segments running in the myocardium. Although, it is considered as a benign anomaly, it may lead to such complications as acute myocardial infarction, ventricular tachycardia, syncope, atrioventricular block and sudden cardiac death. In this study, we aimed to investigate demographic, clinical and angiographic characteristics of the patients with MB found on coronary angiography. Methods: The present study included 71 patients with MB found on coronary angiographies performed in our institution between January 1999 and September 2003. Based on the findings on angiography, the patients were subdivided into group A (n=41) and group B (n=30). The patients in the group A had no atherosclerotic lesion and the patients in the group B had coronary artery disease in addition to MB. Angiographic, demographic and clinical characteristics of both groups were compared. Results: There were no differences between two groups in distribution of gender and risk factors of coronary artery diseases whereas mean age of the patients in the group A was lower (47 +/- 5 years vs 55 +/- 11 years, p = 0.01). Frequency of two or more risk factors for coronary artery disease in a particular patient was significantly higher in the group B (55% vs 30%, p = 0.03). Myocardial bridge was located at proximal or mid segments of left anterior descending artery (LAD) in 40 patients whereas its presence in both LAD and right coronary artery was found only in one patient in group A. Mean bridging percent was 43 +/- 27% in group A. Localization of MB was LAD in 29 patients of group B, which was significantly higher than in group A (p<0.05). Atherosclerotic narrowing developed in only LAD in 14 patients, LAD and other vessels in 7 patients and in the vessels without MB in 9 patients. In patients with MB in LAD atherosclerotic narrowing of vessel developed proximally to the MB. Clinically, stable angina pactoris was seen more frequently in group A than group B (70% vs 35%, p = 0.01), whereas the frequency of acute coronary syndrome was higher in group B (65% vs 30%, p=0.04). In regard to therapeutic approach, more patients in the group A received medical management (80% vs 50%, p=0.01), while more patients in the group B underwent surgical and percutaneous interventions (50% vs 18%, p=0.04). Conclusion: Myocardial bridge probability should be considered in young patients presenting with angina or if the same symptoms are persistent in the patients without more than one risk factor for coronary artery disease. Myocardial bridge may initiate the development of atherosclerotic lesion or may facilitate progression of atherosclerosis in the proximal segment of the vessel. The risk of acute coronary syndrome rises when atherosclerosis is superimposed on MB. Myocardial bridge should be considered in the young patients, presenting with angina or its equivalents without atherosclerotic lesions on coronary angiography