Could mean platelet volume predicts impaired reperfusion and in-hospital major adverse cardiovascular event in patients with primary percutaneous coronary intervention after ST-elevation myocardial infarction?

Due to the positive relation between platelet size and platelet reactivity, a high value of the mean platelet volume [MPV] is an independent risk factor to predict acute myocardial infarction [AMI] and its adverse outcome. Few data are available to determinate the prognostic value of MPV in ST-elevation myocardial infarction [STEMI] patients treated with percutaneous coronary intervention [PCI]. The primary purpose of this study was to evaluate the clinical value of MPV to predict impaired reperfusion and in-hospital major adverse cardiovascular events [MACE] in acute STEMI treated with primary PCI. This study included 203 STEMI patients referring for blood sampling before primary PCI to estimate MPV and determine the thrombolysis in myocardial infarction [TIMI] flow grade, corrected TIMI frame count [CTFC], and in-hospital MACE. The frequency of in-hospital MACE in the group of patients with a high MPV [>/= 10.3 ng/dl] was significantly more than that of the group with a low MPV [<10.3 ng/dl] [37.8% vs. 4.4%, P < 0.001]. The no-reflow phenomenon was more frequent in the patients with a high MPV than that of the patients with a low MPV [17.8% vs. 1.9%, P < 0.001]. The mean MPV in the group of patients with CTFC >/= 40 was significantly more than that of the group of patients with CTFC < 40 [10.9 +/- 0.92 vs. 9.45 +/- 0.85, P = 0.001]. After adjustment for baseline characteristics, a high MPV remained a strong independent factor to predict the no-reflow phenomenon [Odds Ratio [OR]=2.263, 95% Confidence Interval [CI] = 1.47 to 5.97; P < 0.002], in-hospital MACE [OR = 2.49, 95% CI = 1.34 to 4.61; P < 0.004], and CTFC >/= 40 [OR=2.09, 95% CI = 1.22 to 3.39; P < 0.003]. These findings confirmed that not only could admission MPV predict impaired reperfusion and in-hospital MACE in acute STEMI patients treated with PCI, but also it could be considered a practical way to determine higher-risk patients

Primary percutaneous coronary intervention in patients with acute myocardial infarction

Primary percutaneous coronary intervention [primary PCI] is the method of choice in establishing reperfusion in acute myocardial infarction [AMI] patients. The aim of this study was to determine the success rate of primary PCI in a university medical center in Iran with a view to promoting it as a first-line therapy in patients with AMI, especially in centers with established catheterization labs across the country. All cases of AMI admitted between September 2001 and September 2005 underwent primary PCI. The achieved thrombolysis in myocardial infarction [TIMI] flow was recorded, and the patients were followed during the hospital admission for major adverse cardiac events [MACE]. A total of 180 patients, consisting of 36 females and 144 males, with a mean age of 56 +/- 2.1 years were included in the study. The target vessel was the left anterior descending artery in 66.1%, right coronary artery in 27.2%, and left circumflex artery in 6.7% of the cases. The respective rate of anatomical and procedural success was 94.4% and 90%. The rates of mortality, coronary artery bypass grafting [CABG], and reinfarction were 6.7%, 1.1%, and 2.2%, respectively. Most patients were discharged with no complications in less than a week. Anatomical success in patients < 65 years old was 95% versus 92.5% for those >/= 65 years of age. Procedural success in patients < 65 years of age was 93.6% versus 77.5% for those >/= 65 years old [P < 0.05]. No significant relation was detected between the success rate and sex, target vessel, or major coronary artery disease risk factors. More patients in the mortality group had a longer door-to-balloon [DTB] time compared to the surviving group [P < 0.05]. In light of the results of this study, primary PCI may also be practiced as the therapy of choice for AMI patients in centers with established equipment in our region with acceptable rates of MACE and complications. Better procedural success rates are achieved in younger patients and in those with a shorter DTB time