Coronary chronic total occlusion (CTO) is caused by organized thrombi or atherosclerotic plaque progression. The presence of a CTO is an independent predictor of mortality in patients presenting with ST-segment elevation myocardial infarction (STEMI). Platelets have a crucial role in the pathophysiology of atherosclerosis. The aim of this retrospective study was to investigate platelet indices as predictors of CTO in patients with STEMI treated with primary percutaneous coronary intervention (pPCI). A total number of 334 patients admitted for STEMI between January 2011 and December 2013 were included and divided in two groups based on the presence of CTO (48 patients in CTO+ group, 286 patients in CTO-group). Platelet count, mean platelet volume (MPV), platelet distribution width (PDW), platelet-large cell ratio (P-LCR), lymphocyte and neutrophil count determined on admission were analyzed. MPV was larger in patients with CTO compared with patients without CTO (p=0.02), as were PDW (p=0.03) and P-LCR (p=0.01). Platelet-to-lymphocyte ratio (PLT/LYM) was lower in patients with CTO: 105.2 (75.86-159.1) compared to 137 (97-188.1), p<0.01. Receiver-operator characteristic curve analysis identified an area under the curve of 0.61 (95%CI=0.57-0.67, p< 0.01) for PLT/LYM in predicting the presence of a CTO, with a cut-off value at 97.73. Lower values than this were independent predictors of a CTO in multivariate logistic regression analysis, with an Odds Ratio of 2.2 (95%CI=1.15-4.20, p=0.02). Our results support the use of platelet indices and PLT/LYM as predictors of CTO in patients presenting with STEMI.
1. Boos CL, Lip GYH. Assessment of mean platelet volume in coronary artery disease – What does it mean?. Thrombosis Research. 2007; 120:11-13 DOI: 10.1016/j. thromres.2006.09.002
2. Huczek Z, Kochman J, Filipiak KJ, Horszczaruk GJ, Grabowski M, Piatkowski R, et al. Mean platelet volume on admission predicts impaires reperfusion and long-term mortatilty in acute myocardial infarction trated with primary percutaneous coronary intervention. J Am Coll Cardiol. 2005; 46:284-90. DOI: 10.1016/j. jacc.2005.03.065
3. Cakici M, Cetin M, Balli M, Akturk E, Dogan A, Oylumlu M, et al. Predictors of thrombus burden and no-reflow of infarct-related artery in patients with ST-segment elevation myocardial infarction: importance of platelet indices. Blood Coagul Fibrinolysis. 2014 Oct;25(7):709-15. DOI: 10.1097/MBC.0000000000000130
4. 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
5. Kurtul A, Yarlioglues M, Murat SN, Ergun G, Duran M, Kasapkara HA, et al. Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute st-segment elevation myocardial infarction. Am J Cardiol. 2014; 114:342-47. DOI: 10.1016/j.amjcard.2014.04.045
6. Lievens D, von Hundelshausen P. Platelets in atherosclerosis. Thromb Haemost. 2011 Nov; 106(6):827-36. DOI: 10.1160/TH11-08-0592
7. Burke A, Tavora F, Pathology of coronary atherosclerosis, Practical Cardiovascular Pathology, Lippincott Williams&Wilkins, Philadelphia, 2011, pages 83-84.
8. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Taks Force members. Eur Heart J. 2013 Oct; 34(38):2949-3003. DOI: 10.1093/eurheartj/eht296
9. O’Connor SA, Garot P, Sanguineti F, Hoebers LP, Unterseeh T, Benamer H, et al. Meta-analysis of the impact of mortality of non-infarct related artery coronary chronic total occlusion in patients presenting with ST-segment elevation myocardial infarction. Am J Cardiol. 2015 Jul 1;116(1):8-14. DOI: 10.1016/j.amj-card.2015.03.031
10. Kurtul A, Yarlioglues M, Murat SN, Celik IE, Demircelik MB, Ocek AH, et al. Predictors of Chronic Total Occlusion in Nonculprit Artery in Patients With Acute Coronary Syndrome: Mean Platelet Volume and Uric Acid. Angiology. 2015 Jul;66(6):553-9. DOI: 10.1177/0003319714542998
11. Olteanu AL, Mihaila RG, Catana AC, Flucus O, Bus C, Mihalache M. Platelet indices in Philadelphia-negative chronic myeloproliferative neoplasms. Rev Romana Med Lab. 2015;23(2):169-77. DOI: 10.1515/rrlm-2015-0012
12. Khandekar MM, Khurana AS, Deshmukh SD, Kakrani AL, Katdare AD, Inamdar AK. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol. 2006 Feb; 59:146-149. DOI: 10.1136/jcp.2004.025387
13. Dehghani MR, Taghipour-Sani L, Rezaei Y, Rostami R. Diagnostic importance of admission platelet volume indices in patients with acute chest pain suggesting acute coronary syndrome. Indian Heart J. 2014 Nov-Dec; 66(6):622-628. DOI: 10.1016/j.ihj.2014.10.415
14. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14(1):28-32.
15. Vatankulu MA, Sonmez O, Ertas G, Bacaksiz A, Turfan M, Erdogan E, et al. A new parameter predicting chronic total occlusion of coronary arteries: platelet distribution width. Angiology. 2014; 65(1): 60-4. DOI: 10.1177/0003319713502702 DOI: 10.1177/0003319713486339
16. De Luca G, Venegoni L, Iorio S, Secco GG, Cassetti E, Verdoia M et al. Platelet distribution width and the extent of coronary artery disease: results from a large prospective study. Platelets. 2010; 21(7):508-14. DOI: 10.3109/09537104.2010.494743
17. McCabe DJ, Harrison P, Sidhu PS, Brown MM, Machin SJ. Circulating reticulated platelets in the early and late phases after ischaemic stroke and transient ischaemic attack. Br J Haematol 2004;126:861–9. DOI: 10.1111/j.1365-2141.2004.05137.x
18. Legein B, Temmerman L, Biessen EAL, Lutgens E. Inflammation and immune system interactions in atherosclerosis. Cell Mol Life Sci. 2013; 70:3847–69. DOI: 10.1007/s00018-013-1289-1
19. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ergun G, Acikgoz SK, et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndrome. Am J Cardiol. 2014; 114:972-78. DOI: 10.1016/j.amj-card.2014.07.005
20. Dehghani MR, Taghipour-Sani L, Rezaei Y, Rostami R. Diagnostic importance of admission platelet volume indices in patients with acute chest pain suggesting acute coronary syndrome. Indian Heart J. 2014 Nov-Dec; 66(6):622-8. DOI: 10.1016/j.ihj.2014.10.415
21. Acet H, Ertaş F, Akıl MA, Özyurtlu F, Yıldız A, Polat N, et al. Novel predictors of infarct-related artery patency for ST-segment elevation myocardial infarction: Platelet-to-lymphocyte ratio, uric acid, and neutrophil-to-lymphocyte ratio. Anatol J Cardiol. 2015 Aug;15(8):648-56. DOI: 10.5152/akd.2014.5592
22. Thomson SP, McMahon LJ, Nugent CA. Endogenous cortisol: a regulator of the number of lymphocytes in peripheral blood. Clin Immunol Immunopathol 1980;17:506e514.
23. Szodoray P, Timar O, Veres K, Der H, Szomjak E, Lakos G, et al. TH1/TH2 imbalance, measured by circulating and intracytoplasmic inflammatory cytokines— immunological alterations in acute coronary syndrome and stable coronary artery disease. Scand J Immunol. 2006 Sep; 64(3):336–44. DOI: 10.1111/j.1365-3083.2006.01816.x
24. Nunez J, Minana G, Bodi V, Nunez E, Sanchis J, Husser O, et al. Low lymphocyte count and cardiovascular diseases. Curr Med Chem 2011;18(21):3226–33. DOI: 10.2174/092986711796391633