A New Score for Determining Thrombus Burden in STEMI Patients: The MAPH Score

Abstract

Aim to investigate whether the MAPH score, which is a new score that combines blood viscosity biomarkers such as mean platelet volume (MPV), total protein and hematocrit, can be used to predict thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients. Methods A total of 473 consecutive patients with STEMI were included in the study. Intracoronary tirofiban/abciximab infusion was applied to patients with thrombus load ≥3 and these patients (n = 71) were defined as the patient group with high thrombus load. MPV, age, hematocrit and total protein values of the patients were recorded. High shear rate (HSR) and low shear rate (LSR) were calculated from total protein and hematocrit values. Cut-off values were determined for high thrombus load by using Youden index, and score was determined as 0 or 1 according to cut-offs. The sum of the scores was calculated as the MAPH score. Results The mean age of the patients included in the study was 59.6 ± 12.6 (n = 354 male, 74.8%). There was no difference between the groups in terms of gender, HT and DM ( P = .127, P = .402 and P = .576, respectively). In the group with high thrombus load; total protein, MPV and hematocrit values were higher ( P < .001, P = .001 and P = .03, respectively). Comparison of receiver operating characteristic (ROC) curve analysis revealed that the MAPH score had better performance in predicting higher thrombus load than both other self-containing parameters and HSR and LSR. Conclusion The MAPH score may be a new score that can be used to determine thrombus burden in STEMI patients.

Diagnostic performance of whole blood viscosity indices in predicting the presence and severity of coronary artery disease

“…Recently, the MAPH score, incorporating age and MPV parameters in addition to the components of LSR and HSR, has been introduced as a new index for blood viscosity. 15 It has been associated with a high thrombus burden in patients with both ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. 14, 15 In a study involving 260 patients who underwent primary percutaneous coronary intervention and had TIMI 0 flow, it was reported that the MAPH score predicted the presence of TIMI coronary flow after stent implantation with 78% specificity and 45% sensitivity.…”

“…15 It has been associated with a high thrombus burden in patients with both ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. 14, 15 In a study involving 260 patients who underwent primary percutaneous coronary intervention and had TIMI 0 flow, it was reported that the MAPH score predicted the presence of TIMI coronary flow after stent implantation with 78% specificity and 45% sensitivity. 42 In addition to these cohorts as a consequence of atherosclerosis, the predictive role of the MAPH score has also been investigated in patients with CSFP, which is a distinct angiographic clinical entity characterized by delayed coronary opacification in the absence of significant obstructive CAD.…”

The predictive value of MAPH score for determining thrombus burden in patients with non-ST segment elevation myocardial infarction

“…Abacıoğlu et al reported that the MAPH score estimated the thrombus burden in patients with STEMI. In their paper, MPV levels and age were included in the calculation of MAPH score, in addition to total protein and haematocrit [4]. Abacıoğlu et al 's [4] pioneering research found a relationship between blood viscosity and an HTB using the MAPH score in STEMI patients.…”

“…The cut-off levels for MPV, age, total protein and haematocrit were calculated according to the Youden index for HTB. Levels higher than the cut-off were accepted as a score of 1, and MAPH score was evaluated accordingly [4].…”

“…The MAPH score is a straightforward tool used to forecast thrombus load in patients with ST-segment elevation myocardial infarction (STEMI) [4]: a high MAPH score is strongly related to an HTB in patients with STEMI [4]. However, the predictive value of the MAPH score of determining thrombus burden in patients with NSTEMI…”