Prognostic value of a level of decrease in mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) for major adverse cardiovascular events after myocardial infarction without ST-segment elevation: an observational study

Abstract

The current study aimed to explore whether the level of decrease in platelet distribution width (PDW), platelet large cell ratio (P-LCR), and mean platelet volume (MPV) has prognostic value for major adverse cardiovascular events (MACEs) in acute myocardial infarction without ST-segment elevation (NSTEMI) treated by clopidogrel. In this prospective observational cohort study, PDW, P-LCR, and MPV were determined on admission at the hospital and 24 hours after clopidogrel treatment in 170 non-STEMI patients. MACEs were assessed over a one-year follow-up period. Using the Cox regression test, a decrease in PDW showed a significant association with the incidence of MACEs (OR 0.82, 95% CI 0.66-0.99, p=0.049) and overall survival rate (OR 0.95, 95% CI=0.91-0.99, p=0.016). Patients with a decrease in PDW<9.9% had a higher incidence of MACEs (OR 0.42, 95% CI 0.24-0.72, p=0.002) and a lower survival rate (OR 0.32, CI95%=0.12-0.90, p=0.03) than patients who had a decrease in PDW9.9%. In the Kaplan‒Meier analysis using log-rank test, patients who had a decrease in PDW<9.9% had an increased risk for MACEs (p=0.002) and lethal outcomes (p=0.002). However, a decrease in MPV or PLC-R did not have prognostic value. A decrease in PDW<9.9% measured 24 hours after clopidogrel treatment in NSTEMI patients has good prognostic value for determining the short-term risks of MACEs, possibly providing a better risk stratification of those patients.