Relationship between cardiovascular evaluation data on admission and secondary adverse cardiac event rate after acute coronary syndrome

Abstract

The current study aimed to investigate the relationship of clinical data with mean platelet volume (MPV) and QT dispersion values on admission of acute coronary syndrome (ACS) patients to the adverse cardiac event rate in a follow-up period of 20 months after discharge. For this purpose demographic and clinical data with corrected QT dispersion on admission and MPV values of 97 consequtive patients with ACS were recorded, retrospectively. Their history of major adverse cardiac event (MACE) in a 20 months period after ACS was obtained from the hospital records, interviews with the attending physicians and telephone calls to patients. Demographic and clinical data with corrected QT dispersion on admission, and MPV values were compared between groups with and without MACE in terms of statistical significance. In our study, diabetesmellitus, left ventricular ejection fraction (EF) and wall motion score index (WMSI), corrected QT dispersion, total cholesterol, LDL, CK-MB and troponin levels were found significantly related to the secondary MACE rate (p values; 0.046, 0.0001, 0.0001, 0.032, 0.024, 0.002 and 0.0001, respectively). No significant relation was detected between groups with and without MACE in terms of conservative medical follow-up and revascularization history (p=0.774). In the comparison of mean MPV values, there was no statistically significant difference between MPV values of patients with MACE (10.4±1.8 fl) and without MACE (10.3±2 fl) (p=0.799). In addition, the subgroup analysis on acute ST-elevation myocardial infarction cases in our study group did not state a significant relationship between MPV values below/above 10.3 fl and MACE rates (p=0.774). Finally, this retrospective study showed that corrected QT dispersion, diabetes, contractile reserve of left ventricule, total and LDL- cholesterol and peak cardiac enzyme values assessed during ACS might predict MACE.

Keywords

• Acute coronary syndrome
• Mean platelet volume
• QT dispersion
• Secondary

References

1. Arós, F., Osorio, A.L.,Vila, J., Bescós, L.L., Cuñat, J., 2006. Effect of combined beta-blocker and angiotensin-converting enzyme ınhibitor treat- ment on 1-year survival after acute myocardial ınfarction: Findings of the PRIAMHO-II Registry. Rev. Esp. Cardiol. 59, 313-320.
2. Banerjee, S., Varghese, C., Samuel, J., Weideman, R.A., Little, B.B., Kevin, C., 2008. Comparison of the ımpact of short (<) and long-term (≥1 year) clopidogrel use following percutaneous coronary ıntervention on mortality. Am. J. Cardiol. 102, 1159-1162. doi: 10.1016/j.amj- card.2008.06.058.
3. Bodi, V., Sanchis, J., Navarro A., Plancha, E., Chorro, F., 2001. QT dispersion within the first 6 months after an acute myocardial infarction: Relationship with systolic function, left ventricular volumes, infarct related artery status and clinical outcome Int. J. Cardiol. 80, 37-45.
4. Bonde, L., Sorensen, R., Fosbol, E.L., Abildstrom, S.Z., Hansen, P.R., Kober, L., Schramm, T.K., Weeke, P., Olesen, J., Torp-Pedersen, C., Gis- lason, G.H., 2010. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial ınfarction not undergoing percutaneous coronary ıntervention: A nationwide study. J. Am. Col. Cardiol. 55, 1300-1307
5. Colkesen, Y., T. Acil, B., Abayli, F., Yigit, T., Katircibasi, T., Kocum, S., Demircan, A., Sezgin, B., Ozin, H., Muderrisoglu, 2008. Mean platelet volume is elevated during paroxysmal atrial fibrillation: A marker of increased platelet activation? Blood Coagul. Fibrinolysis. 19, 411-414. doi: 10.1097/MBC.0b013e3283049697.
6. COMMIT (Clopidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group, 2005. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 366, 1607-1621.
7. Davies, M.J., Thomas, A.C., 1984. Thrombosis and acute coronary artery lesions in sudden cardiac ischemic death. N. Engl. J. Med. 310, 1137- 1140.
8. Day, C.P., McComb, J.M., Campbell, R.W., 1990. QT dispersion: An indication of arryhtmia risk in patients with long QT intervals. Br. Heart. 63, 342-344.

9. De Luca, G., Suryapranata, H., Ottervanger, J.P., Van’t Hof, A.W., Hoorntje, J.C., Gosselink, A.T., Dambrink, J.H., de Boer, M.J., 2006. Impact of statin therapy at discharge on 1-year mortality in patients with ST-segment elevation myocardial infarction treated with primary angiop- lasty Atherosclerosis. 189, 186-192.
10. Dutcher, J., Kahn, J., Grines, C., 2007. Comparison of left ventricular ejection fraction and exercise capacity as predictors of two- and five-year mortality following acute myocardial ınfarction. Am. J. Cardiol. 99, 436-441.
11. Elwood, P.C., Sweetnam, P.M., 1979. Aspirin and secondary mortality after myocardial infarction. Lancet. 314, 1313-1315.
12. Gottlieb, S., Moss, A., Mcdermott, M., Eberly, S., 1992. Interrelation of left ventricular ejection fraction, pulmonary conjestion and outcome in acute myocardial infarction. Am. J. Cardiol. 69, 977-984.
13. Gruber, A., Smith, R., Barker, B., Sithole, J., Thomson, G.A., Idris, I., 2007. Serum urea and total cholesterol independently predict re-hospitali- sation with a cardiac-related event following an acute ST-elevation myocardial infarction. Eur. J. Int. Med. 18, 531-534.
14. Huczek, Z., Kochman, J., Filipiak, K., Horszczaruk, G., Grabowski, M., 2005. Mean platelet volume on admission predicts ımpaired reperfusion and long-term mortality in acute myocardial ınfarction treated with primary percutaneous coronary intervention. J. Am. Coll. Cardiol. 46, 284-290.
15. Jain, H., Avasthi, R., 2004. Correlation between dispersion of repolarization (QT dispersion) and ventricular ectopic beat frequency in patients with acute myocardial infarction: A marker for risk of arrhythmogenesis? Int. J. Cardiol. 93, 69-73.
16. Kodama, K., Sakagashira, S., Hori, M., 1996. Prognostic significance of diabetes mellitus in patients with acute myocardial infarction after recanalization. Diabetes Res. Clin. Pract. 30, 1-75.
17. Kuch, M., Janiszewski, M., Mamcarz, A., Cudnoch-Jedrzejewska, A., Dłuzniewski, M., 2009. Major adverse cardiac event predictors in survi- vors of myocardial infarction with asymptomatic left ventricular dysfunction or chronic heart failure. Med. Sci. Monit. 15, 40-48.
18. Kyung, H.C., Myung, H., Youngkeun, A.., Korea Acute Myocardial Infarction Registry (KAMIR) Investigators, 2010. Low-density lipoprotein cholesterol level in patients with acute myocardial ınfarction having percutaneous coronary ıntervention (the cholesterol paradox) Am. J. Cardiol. 106, 1061-1068.
19. Lewis, S.J., Sacks, F.M., Mitchell, J.S., 1998. Effect of pravastatin on cardiovascular events in women after myocardial ınfarction: The choles- terol and recurrent events (CARE) trial. J. Am. Coll. Cardiol. 32, 140-146.
20. Libby, P., 2000. Coronary artery injuty and the biology of atherosclerosis: Inflammation, thrombosis, and stabilization. Am. J. Cardiol. 86, 3-9.
21. Lopes, N.H., Paulitsch, Fd. S., Gois, A.F., Pereira, A.C., Stolf, N.A., Dallan, L.O., 2008. MASS study. European Journal of Cardio-Thoracic Surgery. Volume 33, Issue 3, March 2008. 349-354. doi: 10.1016/j.ejcts.2007.11.025.
22. Malmberg, K., Bavenholm, P., Hamste,n A., 1994. Clinical and biochemical factors associated with prognosis after myocardial ınfarction at a young age. J. Am. Coll. Cardiol. 24, 592-599.
23. Özgül, A., Atar, İ., Bal, U.A., Ertan, Ç., Aydınalp, A., Gülmez, Ö., Müderrisoğlu, H., Özin, B. 2007. Koroner arter hastalığı ve metabolik send- romu olan hastalarda QT süresi ve yayılımı Türk Aritmi. Pacemaker ve Elektrofizyoloji Dergisi. 5, 231-237.
24. Paventi, S., Bevilacqua, U., Parafati, M., Luzio, E., Rossi, F. 1999. QT dispersion and early arrhythmic risk during acute myocardial ınfarction. Angiology. 50, 209-211.
25. Rodriguez, A., Bernardi, V., Navia, J., Baldi, J., Grinfeld, L., Martinez, J.,Vogel, D., Grinfeld, R., 2001. ERACI II, Journal of the American College of Cardiology, Volume 37, Issue 1. 51-58.
26. Schoene, N.W., 1997. Design criteria: Tests used to assess platelet function. Am. J. Clin. Nutr. 65, 1665-1685.
27. Schwartz, P.J., Periti, M., Malliani, A. 1975. The long QT syndrome. Am. Heart. J. 89, 378-380.
28. Somberg, J.S., Molnar, J., 2002. Usefulness of QT dispersion as an electrocardiographically derived index. Am. J. Cardiol. 89, 291-294.
29. Trowbridge, A., Slater, D., Kishk, Y.T., Martin, J., 1985. High mean platelet volume after myocardial infraction. B.M.J. 290, 238-239.
30. Van de loo, A., Arendts, W., Hohnloser, S.H., 1994. Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am. J. Cardiol. 74, 1113-1118.
31. Wang, C.L., Lee, W.L., Wu, M.J., Cheng, C.H., Chen, C.H., Shu, K.H., 2002. Increased QTc dispersion and mortality in uremic patients with acute myocardial infarction. Am. J. Kidney. Dis. 39, 539-548.
32. Yang, A., Pizzulli, L., Luderitz, B., 2006. Mean platelet volume as marker of restenosis after percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris. Throm. Res. 117, 371-377.
33. Zaputovic, L., Mavric, Z., Zaninovic-Jurjevic, T., Matana, A., Bradic, N., 1997. Relationship between QT dispersion and the incidence of early ventricular arrhythmias in patients with acute myocardial infarction. Int. J. Cardiol. 62, 211-216.