Does Platelet Distribution Width Correlate with Acute Coronary Syndrome Severity and Coronary Thrombus Burden?

Year 2023, Volume: 13 Issue: 4, 682 - 685, 31.07.2023

Hızır Okuyan

https://doi.org/10.16899/jcm.1190001

Abstract

Aim: Platelets play a pivotal role in the pathogenesis of acute coronary syndrome (ACS), and platelet distribution width (PDW) shows the activities of platelets in circulation. The purpose of this study was to determine the association of PDW with the ACS severity and angiographic intracoronary thrombus burden and Thrombolysis In Myocardial Infarction (TIMI) flow grade.
Materials and Methods: One hundred forty-nine consecutive patients who were diagnosed as having ACS were retrospectively evaluated. Global Registry of Acute Coronary Events (GRACE) scores were calculated from the clinical and laboratory data for ACS severity. TIMI flow grades and thrombus grades of the culprit coronary arteries were calculated for each patient. Patients were grouped into two groups according to their PDW values: high PDW and low PDW. The SPSS 17.0 software was used for statistical analysis.
Results: PDW was found to be correlated with GRACE scores (P<0.01). The high PDW group had higher GRACE scores (139 vs. 126, p<0.05). Lower TIMI flow grades (0 and 1) were seen in the high PDW group (39 vs. 33, p<0.05). No association between intracoronary thrombus load and PDW was found in our study (p=0.082).
Conclusion: In our study, patients with higher PDW levels were older and had higher GRACE scores and lower TIMI flow grades. PDW levels correlate with the ACS severity and TIMI flow grade.

Keywords

Platelet distribution width, TIMI flow, acute coronary syndrome, coronary thrombus

Trombosit Dağılım Genişliği Akut Koroner Sendrom Şiddeti ve Koroner Trombüs Yükü ile İlişkili mi?

Abstract

Amaç: Trombositler, akut koroner sendromun (AKS) patogenezinde önemli bir rol oynar ve trombosit dağılım genişliği (PDW), trombositlerin dolaşımdaki aktivitelerini gösterir. Bu çalışmanın amacı, PDW'nin AKS şiddeti, anjiyografik intrakoroner trombüs yükü ve Miyokard Enfarktüsünde Tromboliz (TIMI) akım derecesi ile ilişkisini belirlemektir.
Gereç ve Yöntem: AKS tanısı alan ardışık 149 hasta geriye dönük olarak değerlendirildi. Akut Koroner Olayların Global Kayıtları (GRACE) skorları, AKS şiddeti için klinik ve laboratuvar verilerinden hesaplanmıştır. Suçlu koroner arterlerin TIMI akım dereceleri ve trombüs dereceleri her hasta için hesaplandı. Hastalar PDW değerlerine göre yüksek PDW ve düşük PDW olmak üzere iki gruba ayrıldı. İstatistiksel analiz için SPSS 17.0 programı kullanıldı.
Bulgular: PDW, GRACE puanları ile korele bulundu (P<0.01). Yüksek PDW grubu daha yüksek GRACE skorlarına sahipti (139'a karşı 126, p<0.05). Yüksek PDW grubunda daha düşük TIMI akış dereceleri (0 ve 1) görüldü (39'a karşı 33, p<0.05). Çalışmamızda intrakoroner trombüs yükü ile PDW arasında ilişki bulunmadı (p=0,082).
Sonuç: Çalışmamızda PDW düzeyi daha yüksek olan hastalar daha yaşlıydı ve GRACE skorları daha yüksek ve TIMI akış dereceleri daha düşüktü. PDW seviyeleri, AKS şiddeti ve TIMI akış derecesi ile ilişkilidir.

Keywords

: Trombosit dağılım genişliği, koroner trombüs, TIMI akışı, akut koroner sendrom

References

• 1. Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part I. Mayo Clin Proc. 2009 Oct;84(10):917-38. doi: 10.1016/S0025-6196(11)60509-0.
• 2. Rondina MT, Weyrich AS, Zimmerman GA. Platelets as cellular effectors of inflammation in vascular diseases. Circ Res. 2013 May 24;112(11):1506-19. doi: 10.1161/CIRCRESAHA.113.300512.
• 3. Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract. 2009 Oct;63(10):1509-15. doi: 10.1111/j.1742-1241.2009.02070.
• 4. Huczek Z, Filipiak KJ, Kochman J, Michalak M, Roik M, Piatkowski R, et al. Baseline platelet size is increased in patients with acute coronary syndromes developing early stent thrombosis and predicts future residual platelet reactivity. A case-control study. Thromb Res. 2010 May;125(5):406-12. doi: 10.1016/j.thromres.2009.09.003.
• 5. Ulucan Ş, Keser A, Kaya Z, Katlandur H, Özdil H, Bilgi M, et al. Association between PDW and long-term major adverse cardiac events in patients with acute coronary syndrome. Heart Lung Circ. 2016 Jan;25(1):29-34. doi: 10.1016/j.hlc.2015.05.017.
• 6. Bekler A, Ozkan MT, Tenekecioglu E, Gazi E, Yener AU, Temiz A, et al. Increased platelet distribution width is associated with severity of coronary artery disease in patients with acute coronary syndrome. Angiology. 2015 Aug;66(7):638-43. doi: 10.1177/0003319714545779.
• 7. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003 Oct 27;163(19):2345-53. doi: 10.1001/archinte.163.19.2345.
• 8. Farooq V, Girasis C, Magro M, Onuma Y, Morel MA, Heo JH, et al. The CABG SYNTAX Score - an angiographic tool to grade the complexity of coronary disease following coronary artery bypass graft surgery: from the SYNTAX Left Main Angiographic (SYNTAX-LE MANS) substudy. EuroIntervention. 2013 Mar;8(11):1277-85. doi: 10.4244/EIJV8I11A196.
• 9. Kern MJ, Moore JA, Aguirre FV, Bach RG, Caracciolo EA, Wolford T, et al. Determination of angiographic (TIMI grade) blood flow by intracoronary Doppler flow velocity during acute myocardial infarction. Circulation. 1996 Oct 1;94(7):1545-52. doi: 10.1161/01.cir.94.7.1545.
• 10. Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP, et al. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation. 2001 May 29;103(21):2550-4. doi: 10.1161/01.cir.103.21.2550.
• 11. Sianos G, Papafaklis MI, Daemen J, Vaina S, van Mieghem CA, van Domburg RT, et al. Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden. J Am Coll Cardiol. 2007 Aug 14;50(7):573-83. doi: 10.1016/j.jacc.2007.04.059.
• 12. Celik T, Kaya MG, Akpek M, Gunebakmaz O, Balta S, Sarli B, et al. Predictive value of admission platelet volume indices for in-hospital major adverse cardiovascular events in acute ST-segment elevation myocardial infarction. Angiology. 2015 Feb;66(2):155-62. doi: 10.1177/0003319713513493.
• 13. Stark K, Massberg S. Interplay between inflammation and thrombosis in cardiovascular pathology. Nat Rev Cardiol. 2021 Sep;18(9):666-682. doi: 10.1038/s41569-021-00552-1.
• 14. Lancé MD, Sloep M, Henskens YM, Marcus MA. Mean platelet volume as a diagnostic marker for cardiovascular disease: drawbacks of preanalytical conditions and measuring techniques. Clin Appl Thromb Hemost. 2012 Nov;18(6):561-8. doi: 10.1177/1076029612458147.
• 15. Koupenova M, Clancy L, Corkrey HA, Freedman JE. Circulating platelets as mediators of immunity, inflammation, and thrombosis. Circ Res. 2018 Jan 19;122(2):337-351. doi: 10.1161/CIRCRESAHA.117.310795.
• 16. Couldwell G, Machlus KR. Modulation of megakaryopoiesis and platelet production during inflammation. Thromb Res. 2019 Jul;179:114-120. doi: 10.1016/j.thromres.2019.05.008.
• 17. Kamińska J, Koper OM, Siedlecka-Czykier E, Matowicka-Karna J, Bychowski J, Kemona H. The utility of inflammation and platelet biomarkers in patients with acute coronary syndromes. Saudi J Biol Sci. 2018 Nov;25(7):1263-1271. doi: 10.1016/j.sjbs.2016.10.015.
• 18. Tong M, Seth P, Penington DG. Proplatelets and stress platelets. Blood. 1987 Feb;69(2):522-8.
• 19. Bessman JD, Williams LJ, Gilmer PR Jr. Platelet size in health and hematologic disease. Am J Clin Pathol. 1982 Aug;78(2):150-3. doi: 10.1093/ajcp/78.2.150.
• 20. Van der Loo B, Martin JF. A role for changes in platelet production in the cause of acute coronary syndromes. Arterioscler Thromb Vasc Biol. 1999 Mar;19(3):672-9. doi: 10.1161/01.atv.19.3.672.
• 21. Heptinstall S, Mulley GP, Taylor PM, Mitchell JR. Platelet-release reaction in myocardial infarction. Br Med J. 1980 Jan 12;280(6207):80-1. doi: 10.1136/bmj.280.6207.80.
• 22. De Luca G, Secco GG, Verdoia M, Cassetti E, Schaffer A, Coppo L, Marino P. Combination between mean platelet volume and platelet distribution width to predict the prevalence and extent of coronary artery disease: results from a large cohort study. Blood Coagul Fibrinolysis. 2014 Jan;25(1):86-91. doi: 10.1097/MBC.0b013e32836577a8.