Platelet Indices and Intracoronary Thrombus Grade as Predictors of In-Hospital Major Cardiovascular Events in Patients with ST Elevation Myocardial Infarction Post Primary Percutaneous Coronary Intervention

I Wayan Gunawan*, I Made Junior Rina Artha, I Kadek Susila Surya Darma

Abstract

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.

Keywords

platelet indices; platelet index; PDW; MPV; Intracoronary Thrombus Grade; major adverse cardiac event; MACE; cardiovascular disease mortality; cardiogenic shock; acute heart failure; malignant arrhythmia; STEMI.

Cite This Article

Gunawan, I. W., Artha, I. M. J. R., Darma, I. K. S. S. (2023). Platelet Indices and Intracoronary Thrombus Grade as Predictors of In-Hospital Major Cardiovascular Events in Patients with ST Elevation Myocardial Infarction Post Primary Percutaneous Coronary Intervention. International Journal of Scientific Advances (IJSCIA), Volume 4| Issue 6: Nov-Dec 2023, Pages 875-893, URL: https://www.ijscia.com/wp-content/uploads/2023/11/Volume4-Issue6-Nov-Dec-No.520-875-893.pdf

Volume 4 | Issue 6: Nov-Dec 2023