Association Between Emergency Department Mean Platelet Volume and Angiographic Severity in Unstable Angina: A Prognostic Study

Öz

Objective Mean platelet volume (MPV) has been associated with thrombotic risk and acute coronary syndrome (ACS) severity in various clinical settings. However, data regarding its prognostic value in unstable angina (UA) patients presenting to the emergency department (ED) are limited. This study aimed to investigate the relationship between MPV measured at ED admission and the angiographic severity of ACS, as quantified by the Gensini score, in patients with UA. A secondary objective was to assess the predictive value of MPV for all-cause mortality. Material and Method This retrospective cohort study included 203 patients diagnosed with ACS between July 2022 and July 2023. MPV and other laboratory parameters were recorded at the time of admission. Coronary angiography findings were evaluated using the Gensini scoring system. Data were analyzed based on Gensini score categories and mortality status. Results MPV values were significantly higher in patients with high Gensini scores and in those who experienced mortality (p <0.001). In patients with UA, MPV demonstrated good predictive value for identifying high Gensini scores (AUC: 0.807, p = 0.006). MPV, age, and troponin were associated with angiographic severity, while MPV, neutrophil-to-lymphocyte ratio (NLR), and Gensini score were independently associated with mortality. In the overall cohort, MPV remained a strong predictor of mortality (AUC = 0.777, p <0.001). Multivariate analysis revealed that MPV (OR: 4.503; 95% CI: 1.233–16.443; p = 0.023) and NLR (OR: 1.826; 95% CI: 1.164–2.864; p = 0.009) were independent predictors of mortality in patients with UA. Conclusion MPV measured at the time of ED presentation independently predicts angiographic severity and shortterm mortality in patients with unstable angina, underscoring its potential utility for early risk stratification and management decisions.

Anahtar Kelimeler

• Acute coronary syndrome
• Emergency medicine
• Gensini
• Mean platelet volume
• Mortality

Kaynakça

1. 1. Tutar M, Kocak HG, Kocak M. Geographical variations and predictors of coronary artery disease mortality in Turkiye: an environmental and behavioral analysis. BMC Cardiovasc Disord. 2024;24:554.
2. 2. Braunwald E, Morrow DA. Unstable angina: is it time for a requiem? Circulation. 2013;127:2452-7.
3. 3. Pal R, Bagarhatta R, Gulati S, et al. Mean platelet volume in patients with acute coronary syndromes: a supportive diagnostic predictor. J Clin Diagn Res. 2014;8:MC01-4.
4. 4. Ekici B, Erkan AF, Alhan A, et al. Is mean platelet volume associated with the angiographic severity of coronary artery disease? Kardiol Pol. 2013;71:832-8.
5. 5. Qiu Q, Zhu G, Peng G, et al. Correlation between mean platelet volume and Gensini score in patients with coronary heart disease in different diabetic states. Heart Surg Forum. 2023;26:E680-6.
6. 6. Ulusoy RE, Yokuşoğlu M, Kırılmaz A, et al. Mean platelet volume in ST elevation and non-ST elevation myocardial infarction. Gulhane Med J. 2011;53:114-8.
7. 7. Nurkalem Z, Alper AT, Orhan AL, et al. Mean platelet volume in patients with slow coronary flow and its relationship with clinical presentation. Turk Kardiyol Dern Ars. 2008;36:363-7.
8. 8. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983;51:606.

9. 9. Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost. 2010;8:148-56.
10. 10. Ahamed H, Henry RA, Pai R. Association of mean platelet volume and acute coronary syndrome. Int J Res Med Sci. 2017;5:1217-20.
11. 11. Beceren NG, Armağan HH, Oğuzlar FÇ, et al. Can mean platelet volume be a prognosis predictor in viral infections: an example of COVID-19. Heliyon. 2023;9:e21983.
12. 12. Aksu F, Ahmed SA. Gensini score's severity and its relationship with risk factors for coronary artery disease among patients who underwent angiography in Somalia's largest PCI centre. Int J Gen Med. 2024;17:187-92.
13. 13. Zhang L, Hailati J, Ma X, et al. Analysis of risk factors for different subtypes of acute coronary syndrome. J Int Med Res. 2021;49:03000605211008326.
14. 14. Andronescu AM, Delcea C, Enache V, et al. Mean platelet volume variability in young patients with non-ST elevation acute myocardial infarction. J Med Life. 2014;7:107-13.
15. 15. Ruan W, Wang M, Sun C, et al. Correlation between neutrophil-to-lymphocyte ratio and stability of carotid plaques. Clin Neurol Neurosurg. 2022;212:107055.
16. 16. Galimzhanov A, Tun HN, Sabitov Y, et al. The prognostic value of mean platelet volume in patients with coronary artery disease: An updated systematic review with meta-analyses. Eur J Clin Invest.2024;54:e14295.
17. 17. Mir AA, Khan AA, Sheikh JM, et al. Analysis of platelet volume indices and their utility in acute coronary syndrome. Heart Views. 2024;25:229-35.