Predictors of thrombus burden and no-reflow of infarct-related artery in patients with ST-segment elevation myocardial infarction

Abstract

Preprocedural high-thrombus burden (HTB) of infarct-related artery (IRA) is a harbinger of procedural complications following primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). The HTB of IRA can lead to poor outcomes by various mechanisms, including no-reflow phenomenon, increased myocardial necrosis and with subsequent reduced survival benefit at follow-up. In this study, we investigated the relationship between all platelet indices on admission and thrombus burden and the no-reflow phenomenon after primary PCI of IRA in patients with STEMI. We retrospectively enrolled 475 patients with STEMI undergoing primary PCI. Study population was divided into two groups according to the thrombolysis in myocardial infarction thrombus grade of IRA as low-thrombus burden or HTB. There were no statistically significant differences in platelet indices, including platelet count, platelet-large cell ratio (P-LCR), mean platelet volume (MPV) and platelet distribution with (PDW) among the groups. However, in the subgroup analysis, P-LCR, MPV and PDW were significantly higher in the no-reflow patients than reflow patients despite similar platelet count (P for all < 0.001). The cutoff value of P-LCR for predicting no-reflow was 26.5% with a sensitivity of 67.0% and a specificity of 62% (area under the curve, 0.689; 95% confidence interval, 0.614-0.765; P < 0.001). Furthermore, P-LCR, MPV and PDW had similar AUC (0.689, P < 0.001; 0.688, P < 0.001; and 0.677, P < 0.001; respectively) for predicting no-reflow phenomenon after primary PCI. As a result, all of the platelet indices have no effect on thrombus load of IRA, however, these parameters seem to impair epicardial perfusion after primary PCI.

Does mean platelet volume predict the location of the infarct-related artery in non-ST-segment elevation myocardial infarction patients?

“…However, we did not find any significant difference in MPV value depending on these angiographic findings. This result was similar to a recent report conducted in patients with ST-elevation myocardial infarction, which showed that the MPV was comparable between patients with high-thrombus burden and those with a low-thrombus burden [8]. These results suggested that the MPV was not directly related with ongoing thrombus burden, though a high MPV has been shown to predict future thromboembolic events.…”

Platelet indices and platelet-to-lymphocyte ratio predict coronary chronic total occlusion in patients with acute ST-elevation myocardial infarction

“…A higher MPV has been associated with more extensive myocardial necrosis and subsequent heart failure [1], increased incidence of myocardial no-reflow, as well as mortality [2] in patients presenting with STEMI. Platelet-large cell ratio (P-LCR) and platelet distribution width (PDW) have also been associated with impaired reperfusion in patients with STEMI [3,4]. In recent years, platelet-to-lymphocyte ratio (PLT/LYM) and platelet-to neutrophil ratio (PLT/NEU) have been investigated as predictors of no-reflow in STEMI [5].…”

Mean platelet volume: a potential biomarker of the risk and prognosis of heart disease

“…An elevated MPV correlates with poor clinical outcomes among survivors of MI in the era of thrombolysis, and an impaired response to thrombolysis in those with ST segment elevation myocardial infarction (STEMI) [28,55]. MPV is also a strong independent predictor of impaired angiographic reperfusion, in-hospital major adverse cardiovascular events, and 30-day, 6-month, 12-month, and 2-year mortality from STEMI treated via primary PCI [26,30-33,36-38,56]. In addition, a higher MPV on admission is independently associated with impaired microvascular perfusion, a poor postintervention myocardial blush grade, decreased post-PCI thrombolysis, and a poorer myocardial infarction flow grade (thrombolysis in myocardial infarction [TIMI]) in STEMI patients treated via primary PCI [33-36,57].…”

“…It was suggested that monitoring of MPV after PCI might aid risk stratification. MPV cutoffs for predicting poor clinical outcomes in patients with unselected coronary artery disease treated via PCI are 8.00 to 9.25 fL (Table 1) [11,14,16,26,30,31,33,36-38,43-48,56,60,61]. …”