Efficacy of Hematological and Coagulation Parameters in the Diagnosis and Prognosis of Patients with Acute Coronary Syndrome
Background: The diagnosis and management of acute coronary syndrome (ACS) have improved significantly over the past few decades; however, the recognition of myocardial ischemia still proves to be a dilemma for cardiologists. The aim of this study was to determine the role of hematological and coagulation parameters in the diagnosis and prognosis of patients with ACS.
Methods: This prospective study recruited 250 patients with ACS and 250 healthy controls. The diagnostic role of hematological and coagulation parameters was assessed by comparing the patients with ACS with the control group. The relationships between these parameters and mortality were determined by dividing the patients into 2 groups: Group A (discharged) and Group B (patients who died within 30 days of follow-up). Multivariate Cox regression analysis was performed to calculate the hazard ratio (HR).
Results: The mean age of the patients was 55.14±10.71 years, and 65.2% of them were male. Prothrombin time (P<0.001), activated partial thromboplastin time (P<0.001), mean platelet volume (MPV) (P<0.001), white blood cell (WBC) count (P<0.001), and red blood cell distribution width (RDW) (P<0.001) were significantly higher in the case group than in the control group. WBC count (P<0.001), RDW (P<0.001), and MPV (P<0.001) were significantly higher in the controls than in the case group. The Cox regression model showed that RDW above 16.55% (HR=6.8), MPV greater than 11.25 fL (HR=2.6), and WBC higher than 10.55×103/μL (HR=6.3) were the independent predictors of mortality.
Conclusion: In addition to being the independent predictors of short-term mortality, RDW, WBC, and MPV when used together with the coagulation profile may aid in the diagnosis of ACS in patients presenting with chest pain.
Lippi G, Montagnana M, Salvagno GL, Guidi GC. Potential value for new diagnostic markers in the early recognition of acute coronary syndromes. CJEM 2006; 8:27–31.
WHO. The global burden of disease: 2004 update. Available at: www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html
Clark AM, Hartling L, Vandermeer B, McAlister FA. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005; 143:659–72.
Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. J Am CollCardiol 2007; 50:2173–95.
Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am CollCardiol 2006; 48:1-11.
Aydınlı B, DemirA, Güçlü ÇY, Bölükbaşı D, Ünal EU, Koçulu R, Selçuk G. Hematological predictors and clinical outcomes in cardiac surgery. Journal of anesthesia 2016 Oct 1;30(5):770-8.
Dehghani MR, Rezaei Y, Taghipour-Sani L. White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome. Cardiol J 2015 Jul 1;22(4):437-45.
The Area Under an ROC Curve [Internet]. Gim.unmc.edu. 2017 [cited 25 February 2017]. Available from: http://gim.unmc.edu/dxtests/roc3.htm
Avramakis G, Papadimitraki E, Papakonstandinou D, Liakou K, Zidianakis M, Dermitzakis A, Mikhailidis DP, Ganotakis ES. Platelets and white blood cell subpopulations among patients with myocardial infarction and unstable angina. Platelets 2007; 18: 16-23.
Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, McCabe CH, Braunwald E, Gibson CM. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy- Thrombolysis In Myocardial Infarction 18 trial) substudy. J Am CollCardiol 2002; 40: 1761-8.
Libby P, Simon DI. Inflammation and thrombosis: the clot thickens. Circulation 2001; 103: 1718-20.
Smyth DW, Martin JF, Michalis L, Bucknall CA, Jewitt DE. Influence of platelet size before coronary angioplasty on subsequent restenosis. Eur J Clin Invest 1993; 23: 361-7.
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 ClinPathol 2006; 59: 146-9.
Chu H, Chen WL, Huang CC, Huang HY, Kuo HY, Gau CM, Chang YC, Shen YS. Diagnostic performance of mean platelet volume for patients with acute coronary syndrome visiting an emergency department with acute chest pain: the Chinese scenario. Emerg Med J 2011;28: 569-74.
Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, Mohler ER, Reilly MP, Berger JS. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J ThrombHaemost 2010; 8: 148-56.
Yilmaz MB, Cihan G, Guray Y, Guray U, Kisacik HL, Sasmaz H, Korkmaz S. Role of mean platelet volume in triagging acute coronary syndromes. J Thromb Thrombolysis 2008: 26: 49-54.
Yaghoubi A, Golmohamadi Z, Alizadehasl A, Azarfarin R. Role of platelet parameters and haematological indices in myocardial infarction and unstable angina. J Pak Med Assoc 2013;63(1133).
Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, Swedberg K, Wang D, Yusuf S, Michelson EL, Granger CB. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am CollCardiol. 2007; 50:40-47.
Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2008; 117: 163-168.
Uyarel H, Ergelen M, Cicek G, Kaya MG, Ayhan E, Turkkan C, Yildirim E, Kirbas V, Onturk ET, Erer HB, Yesilcimen K. Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. Coron Artery Dis 2011; 22:138-144.
Wang YL, Hua Q, Bai CR, Tang Q. Relationship between red cell distribution width and short-term outcomes in acute coronary syndrome in a Chinese population. Intern Med 2011; 50: 2941-5.
Su C, Liao LZ, Song Y, Xu ZW, Mei WY. The role of red blood cell distribution width in mortality and cardiovascular risk among patients with coronary artery diseases: a systematic review and meta-analysis. Journal of thoracic disease. 2014 Sep 28;6(10):1429-40.
Weiss G, Goodnough LT. Anemia of chronic disease. New Engl J Med 2005; 352: 1011-23.
Kato H, Ishida J, Imagawa S, Saito T, Suzuki N, Matsuoka T, Sugaya T, Tanimoto K, Yokoo T, Ohneda O, Sugiyama F. Enhanced erythropoiesis mediated by activation of the renin angiotensin system via angiotensin II type 1a receptor. FASEB J 2005; 19: 2023-5.
Davi G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med 2007; 357: 2482- 2494.
Martin JF, Bath PM, Burr ML. Influence of platelet size on outcome after MI. Lancet 1991; 338:1409–11.
Pal R, Bagarhatta R, Gulati S, Rathore M, Sharma N. Mean platelet volume in patients with acute coronary syndromes: a supportive diagnostic predictor. Journal of clinical and diagnostic research: Journal of Clinical and Diagnostic Research 2014 Aug;8(8):MC01.
Kiliçli-Çamur N, Kiliçli-Camur N, Konuralp C, Eskiser A. Could mean platelet volume be a predictive marker for acute myocardial infarction. Med SciMoni. 2005;11:CR387–92.
Klovaite J, Benn M, Yazdanyar S, Nordestgaard BG. High plaelet volume and increased risk of myocardial infarction: 39 531 participants from the general population. J ThrombHaemost 2011; 9: 49–56.
Butkiewicz AM, Kemona H, Dymicka-Piekarska V, Bychowski J. Betathromboglobulin and platelets in unstable angina. Kardiol Pol 2003; 58:449- 55.
Lopez-Cuenca AA, Tello-Montoliu A, Roldan V, Perez-Berbel P, Valdes M, Marin F. Prognostic value of mean platelet volume in patients with non-ST-elevation acute coronary syndrome. Angiology 2012; 63: 241–244. 25.
Azab B, Torbey E, Singh J, Akerman M, Khoueiry G, Mcginn Jr JT, Widmann WD, Lafferty J. Mean platelet volume/platelet count ratio as a predictor of long term mortality after nonST elevation myocardial infarction. Platelets 2011; 22: 557–566.
Ault KA, Rinder HM, Mitchell J, Carmody MB, Vary CP, Hillman RS. The signiﬁcance of platelets with increased RNA content (reticulated platelets). A measure of the rate of thrombopoiesis. Am J Clin Pathol 1992;98:637–46.
Sewell R, Ibbotson RM, Phillips R, Carson P. High mean platelet volume after myocardial infarction: is it due to consumption of small platelets? Br Med J 1984;289:1576–8.
Meisinger C, Prokisch H, Gieger C, Soranzo N, Mehta D, Rosskopf D, Lichtner P, Klopp N, Stephens J, Watkins NA, Deloukas P. A genome-wide association study identifies three loci associted with mean platelet volume. Am J Human Genetics 2009; 84: 66–71.
Soranzo N, Spector TD, Mangino M et al. A genome-wide meta-analysis identifies 22 loci associated with eight hematological parameters in the HaemGen consortium. Nat Genet 2009; 41: 1182–1190.
Núñez J, Fácila L, Llàcer À, Sanchís J, Bodí V, Bertomeu V, Sanjuán R, Blasco ML, Consuegra L, Bosch MJ, Chorro FJ. Prognostic value of white blood cell count in acute myocardial infarction: long-term mortality. Revista Española de Cardiología (English Edition) 2005 Jun 1;58(6):631-9.
Huang G, Zhong XN, Zhong B, Chen YQ, Liu ZZ, Su L, Ling ZY, Cao H, Yin YH. Significance of white blood cell count and its subtypes in patients with acute coronary syndrome. Eur J Clin Invest 2009;39(5):348–358.
Wong CK, French JK, Gao W, White HD. Relationship between initial white blood cell counts, stage of acute myocardial infarction evolution presentation, and incidence of Thrombolysis In Myocardial Infarction-3 flow after streptokinase. Am Heart J 2003; 145:95-102.
Engler RL, Dahlgren MD, Morris DD, Peterson MA, Schmid-Schonbein GW. Role of leukocytes in response to acute myocardial ischemia and reflow in dogs. Am J Physiol 1986; 251:H314
Neumann FJ, Zohlnhofer D, Fakhoury L, Ott I, Gawaz M, Schomig A. Effect of glycoprotein IIb/IIIa receptor blockade on platelet-leukocyte interaction and surface expression of the leukocyte integrin Mac-1 in acute myocardial infarction. J Am CollCardiol 1999; 34:1420-6.
Irwin MW, Mak S, Mann DL, Qu R, Penninger JM, Yan A, Dawood F, Wen WH, Shou Z, Liu P. Tissue expression and immunolocalization of tumor necrosis factor-alpha in postinfarction dysfunctional myocardium. Circulation 1999;99:1492-8.
Cotter G, Kaluski E, Milo O, Blatt A, Salah A, Hendler A, Krakover R, Golick A, Vered Z. LINCS: L-NAME (a NO synthase inhibitor) in the treatment of refractory cardiogenic shock: a prospective randomized study. Eur Heart J 2003; 24:1287-95.
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