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J Korean Soc Emerg Med > Volume 28(5); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(5): 514-525.
응급진료센터에 내원한 ST 분절 상승 심근 경색 환자에서 혈소판 용적 지표의 연속 측정을 통한 30일 사망률 예측의 유용성
유지나1, 유제성1, 정성필1, 공태영1, 고동률1, 김시내2, 주영선1, 황윤정1, 좌민홍1, 박인철1
1연세대학교 의과대학 응급의학교실
2연세대학교 의과대학 연구부 통계지원팀
Usefulness of Serial Measurement of the Platelet Volume Indices to Predict 30-day Mortality in Patients with ST Segment Elevation Myocardial Infarction
Gina Yu1, Je Sung You1, Sung Phil Chung1, Taeyoung Kong1, Dongryul Ko1, Sinae Kim2, Youngseon Joo1, Yoon Jung Hwang1, Minhong Choa1, Incheol Park1
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Taeyoung Kong ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: grampian@yuhs.ac,
Received: June 14, 2017; Revised: June 14, 2017   Accepted: August 9, 2017.  Published online: October 31, 2017.
Among the survivors of a ST elevation myocardial infarction (STEMI), higher platelet volume indices (mean platelet volume, MPV; platelet distribution width, PDW) are associated with impaired reperfusion and ventricular dysfunction. This study examined the relationship between the platelet volume indices and 30-day mortality with STEMI patients who underwent primary percutaneous coronary intervention (PCI).
This retrospective cohort study included patients presenting to the emergency department with STEMI between January 2011 and May 2016. The platelet volume indices were measured serially, using an automatic hematology analyzer, from admission to 24 hours after admission. The prognostic value of MPV, PDW for the 30-day mortality was determined by Cox proportional hazards model analysis.
A total of 608 STEMI patients, who underwent reperfusion, were enrolled in this study. According to the multivariable Cox proportional hazard model, higher MPV (hazard ratio [HR], 1.414; 95% confidence interval [CI], 1.024-1.953; p=0.035) and PDW (HR, 1.043; 95% CI, 1.006-1.083; p=0.024) values at time-24 (24 hours after admission) were significant risk factors for the 30-day mortality. A MPV value >8.6 fL (HR, 5.953; 95% CI, 2.973-11.918; p<0.001) and PDW value >56.1% (HR, 5.117; 95% CI, 2.640-9.918; p<0.001) at time-24 were associated with an increased risk of 30-day mortality.
The platelet volume indices without an additional burden of cost or time, can be measured rapidly and simply. Higher MPV and PDW levels predict independently the 30-day mortality in patients with STEMI after PCI.
Key words: ST Elevation myocardial infarction, Mean platelet volume, Platelet activation, Prognosis
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