MEAN PLATELET VOLUME CAN BE A POWERFUL INDEPENDENT PREDICTOR FOR 1-YEAR CLINICAL OUTCOMES IN PATIENTS WITH CORONARY ARTERY DISEASE UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

초록

Background: Platelet activation plays a pivotal role in the pathogenesis of coronary artery disease. Platelet size, measured as mean platelet volume (MPV) has been reported to be correlated with platelet reactivity. Thus, we aimed to investigate the impact of MPV on 1-year clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Methods: A total of 738 consecutive patients who underwent PCI between May 2010 and April 2011 were enrolled and divided into two groups based on the mean level of MPV: the high MPV group (MPV ≥9.0fL, n=340, 46%) and the low MPV group (MPV <9fL, n=398, 54%). Major adverse cardiovascular events (MACEs) at 1year, defined as the composite of all-cause death, non-fatal myocardial infarction (MI), stroke, revascularization, or admission for heart failure, were compared between both groups. Results: The mean level of MPV was 9.0±1.1fL.The prevalence of acute MI was significantly higher in the high MPV group than in the low MPV group (69.1% vs. 30.4%, p<0.001). The high MPV group had higher level of CK-MB than the low MPV group (median [interquartile range], 31.7 ng/ mL [3.0-143.7] vs. 2.5ng/mL [1.3-11.2], p<0.001). In addition, systolic dysfunction (ejection fraction <40%) was more frequent in the high MPV group compared with the low MPV group (13.3% vs. 5.6%, p<0.001). The cumulative incidence of MACEs at 1 year was significantly higher in the high MPV group than in the low MPV group (11.5% vs. 5.8%, p=0.004, respectively). In sub-group analysis, the cumulative incidence of 1-year MACEs was significantly different between the high and low MPV groups in patients with acute MI (12.3% vs. 4.1%, p=0.013), but not in patients without acute MI (9.5% vs. 6.5%, p=0.280). By multivariate analysis adjusting for age, sex, peak level of CK-MB, or the presence of diabetes, acute MI or systolic dysfunction, the high MPV level was independently associated with 1-year MACEs (adjusted HR 2.52, 95% CI 1.34-4.76, p=0.004). Conclusions: The level of MPV can be a powerful, independent predictor of 1-year MACEs in patients with coronary artery disease undergoing PCI.