White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome

Background: Total white blood cell (WBC) count and mean platelet volume have previously been shown to predict outcomes in acute coronary syndrome (ACS) patients. In this prospective study, we sought to determine the prognostic value of baseline WBC count to mean platelet volume ratio (WMR) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Methods: A total of 490 patients with NSTE-ACS were prospectively enrolled. The relationship between baseline WMR and major adverse cardiovascular events (MACE) incidence was assessed during a mean follow-up of 330.8 ± 38 days. Results: The patients’ mean age was 60.4 ± 12.9 year, 59% of them were male. The patients were categorized into two groups based on WMR values, high- and low-WMR groups (< 755 vs. ≥ 755). The incidence of MACE was significantly higher in high-WMR compared with that of low-WMR group (22.4% vs. 10.7%, p < 0.001). Total WBC counts (median 7.9 vs. 6.9 ×103/μL, p = 0.004), neutrophil count (median 4.6 vs. 4.2 ×103/μL, p = 0.021), and WMR (median 863.2 vs. 731.5, p = 0.001) were significantly higher in the MACE-positive than MACE-negative group. The high-WMR was found to be significantly associated with the MACE-free survival rate (p < 0.001). In an adjusted cox regression model, the elevated WMR was independently predicted the incidence of MACE (hazard ratio 2.419, 95% CI 1.515–3.862, p < 0.001). Conclusions: The elevated baseline WMR independently predicted the MACE incidence in patients with NSTE-ACS during long-term follow-up.

Diagnostic importance of admission platelet volume indices in patients with acute chest pain suggesting acute coronary syndrome

Objective: Acute coronary syndrome (ACS) is a challenging issue in cardiovascular medicine. Given platelet role in atherothrombosis, we sought to determine whether platelet indices can be used as diagnostic tests for patients who suffered from an acute chest discomfort. Methods: We prospectively enrolled 862 patients with an acute chest pain and 184 healthy matched controls. They were divided into four groups: 184 controls, 249 of non-ACS, 421 of unstable angina (UA), and 192 of myocardial infarction (MI) cases. Blood samples were collected at admission to the emergency department for routine hematologic tests. Results: The mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) were significantly greater in patients with MI compared with those of non-ACS or control subjects. Negative and significant correlations existed between MPV, PDW, and P-LCR values and platelet count (P < 0.001). Receiver operating characteristic (ROC) curves showed that the MPV, PDW, and P-LCR with cut-off values of 9.15 fL, 11.35 fL, and 20.25% and with area under the curves of 0.563, 0.557, and 0.560, respectively, detected MI patients among those who had chest discomfort. The sensitivities and specificities were found to be 72% and 40%, 73% and 37%, and 68% and 44% for MPV, PDW, and P-LCR, respectively. Conclusion: An elevated admission MPV, PDW, and P-LCR may be of benefit to detect chest pain resulting in MI from that of non-cardiac one, and also for risk stratification of patients who suffered from an acute chest discomfort