Abstract

Objectives: Routine biomarkers used to diagnose acute coronary syndrome are undetectable in considerable number of patients especially in early stage of ACS. Early stages ACS involves platelet activation hence change in platelet morphology leading to increase in PDW. Here we aimed to study the diagnostic importance of PDW in acute coronary syndrome.

Materials and Methods: A hospital based case-control study was conducted in the period between February 2019 to February 2020. 77 cases and 77 controls satisfying the inclusion and exclusion criteria and having given an informed consent to participate in the study were included in the study. All consecutive patients presenting with the chest pain of < 24 hours duration with ECG changes consistent with ACS with/without raised cardiac biomarkers were taken as cases and age, sex matched non ACS patients were taken as controls. In both groups platelet count and PDW were measured.

Results: The mean age of the cases enrolled in the study was 56.81 + 12.86 years and controls enrolled in the study was 56.19 + 12.35 years (p = 0.764). The mean left ventricular ejection fraction (LVEF) was significantly lower in case arm compared to control arm (46.51 + 5.83 Vs 59.32 + 1.70; p < 0.001). In comparison to control group the case arm had lower platelet count (207.81 + 34.29 × 107/L Vs 226.60 + 50.44 × 107/L; p = 0.008) and higher platelet distribution width (17.45 + 2.57 fL Vs 16.58 + 2.44 fL; p = 0.033). The area under the receiver operative curve was used as a predictor of ACS and it showed that the PDW cut-off value of 17.8 fL, the sensitivity and specificity of PDW in diagnosing acute coronary syndrome was found 84.4% and 53.2%, respectively.

Conclusion: Our data indicate that both high PDW and low platelet count are early indicators of ACS and it can be used with other cardiac biomarkers for early diagnosis of ACS. It is relatively cheaper, easily available and complementary to other tests used in the patients presenting with chest pain in emergency room.

Keywords: Acute Coronary Syndrome; Platelet Count; Platelet Distribution Width; Diagnosis; Marker

References

1. Gupta, Rajeev., et al. “Trends in Coronary Heart Disease Epidemiology in India”. Annals of Global Health2 (2016): 307-315.
2. Lippi Giuseppe., et al. “Increased mean platelet volume in patients with acute coronary syndromes”. Archives of Pathology and Laboratory Medicine9 (2009): 1441-1443.
3. Lippi Giuseppe., et al. “Potential value for new diagnostic markers in the early recognition of acute coronary syndromes”. CJEM1 (2006): 27-31.
4. Dehghani Mohammad Reza., et al. “Diagnostic importance of admission platelet volume indices in patients with acute chest pain suggesting acute coronary syndrome”. Indian Heart Journal6 (2014): 622-628.
5. Endler Georg., et al. “Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery disease”. British Journal of Haematology2 (2002): 399-404.
6. Chu S G., et al. “Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis”. Journal of Thrombosis and Haemostasis: JTH1 (2010): 148-156.
7. De Luca Giuseppe., et al. “Mean platelet volume and the extent of coronary artery disease: results from a large prospective study”. Atherosclerosis1 (2009): 292-297.
8. Pervin Silpi., et al. "Platelet distribution width is an early indicator of acute coronary syndrome”. University Heart Journal1 (2013): 3-8.
9. Turk Ugur., et al. “The relationship between platelet indices and clinical features of coronary artery disease”. Kardiologia Polska11 (2013): 1129-1134.
10. Assiri Abdullah S., et al. “Diagnostic importance of platelet parameters in patients with acute coronary syndrome admitted to a tertiary care hospital in southwest region, Saudi Arabia”. Journal of the Saudi Heart Association 1 (2012): 17-21.
11. Akanda MAK., et al. "Demographic profile, clinical presentation & angiographic findings in 637 patients with coronary heart disease”. Faridpur Medical College Journal2 (2011): 82-85.
12. Khandekar MM., et al. “Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario”. Journal of Clinical Pathology2 (2006): 146-149.
13. Patil KS and Karchi SD. “A comparative Study of Platelet Indices in Acute Coronary Syndrome”. International Journal of Contemporary Medical Research3 (2017): 657-660.
14. Ardakani N Mesbah., et al. "Evaluation of platelet indices and count in ischemic heart disease patients compared to normal population”. Indian Journal of Cardiology 9 (2006): 17-22.
15. Varol Ercan., et al. “Mean platelet volume is elevated in patients with myocardial infarction with normal coronary arteries, as in patients with myocardial infarction with obstructive coronary artery disease”. Scandinavian Journal of Clinical and Laboratory Investigation5 (2009): 570-574.
16. Cemin Roberto., et al. “Blood cells characteristics as determinants of acute myocardial infarction”. Clinical Chemistry and Laboratory Medicine7 (2011): 1231-1236.
17. Yilmaz Mehmet Birhan., et al. “Role of mean platelet volume in triagging acute coronary syndromes”. Journal of Thrombosis and Thrombolysis1 (2008): 49-54.
18. Bekler Adem., et al. “Increased Platelet Distribution Width Is Associated With Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome”. Angiology7 (2015): 638-643.

Citation

Citation: Manish Kapoor., et al. “A Study of the Diagnostic Importance of Platelet Distribution Width in Acute Coronary Syndrome". Acta Scientific Cardiovascular System 1.1 (2021): 01-06.

Copyright

Copyright: © 2021 Manish Kapoor., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.