Author + information
- Bahadır Şarlı1,
- Ahmet O Baktır1,
- Hayrettin Sağlam1,
- Hüseyin Arınç1,
- Serkan Kurtul1,
- Mahmut Akpek2 and
- Mehmet G Kaya2
In a significant proportion of patients with ST elevation myocardial infarction (STEMI), microvascular and myocardial reperfusion can not be regained in spite of successfully restored Thrombolysis In Myocardial Infarction (TIMI) grade 3 epicardial blood flow. Myocardial blush grade (MBG) is a reliable marker for microvascular patency and predicts short and long term mortality after primary PCI in patients with acute STEMI, independently of other variables. Mean platelet volume (MPV), a unique measure of platelet size, is an indicator of platelet reactivity. In this study, we aimed to investigate the relation of admission MPV with post-interventional MBG in patients with STEMI and TIMI grade 3 flow at infarct artery after primary PCI.
Three hundred and ten patients were selected as study group among patients with STEMI and TIMI grade 3 epicardial blood flow after primary PCI. Blood samples for analysis were obtained during initial evaluation of patients at emergency department. Myocardial blush grade of patients were classified at the end of angioplasty. Patients with MBG 0 and 1 were defined as having poor myocardial blush and patients with MBG 2 and 3 were defined as having well myocardial blush.
Patients with poor myocardial blush had higher admission MPV (10.5±1.3 fL to 9.1±1fL, p<0.001), higher peak creatine kinase myocardial band isoensyme levels (260±53 U/L to 190±38 U/L, p<0.001), higher white blood cell (WBC) count (11.3±4x103/μl to 10.3±3x103 /μl, p=0.012) and lower left ventricular ejection fraction (LVEF) (42±7% to 51±8%, p<0.001) compared to patients with well myocardial blush. Linear regression analysis showed that admission MPV was significantly associated with post-interventional MBG (coefficient=0.598, p<0.001). Cardiovascular mortality (13% to 5%, p=0.013) and acute-subacute stent thrombosis at 3 months (12% to 8%, p=0.028) were significantly higher in patients with poor post-interventional myocardial blush compared to those with well myocardial blush.
Mean platelet volume measured at admission is significantly associated with poor post-interventional MBG in patients with STEMI and TIMI grade 3 flow at infarct artery after primary PCI.