Correspondence
Mean platelet volume may not have a role in the prediction of adverse
events after percutaneous coronary intervention in patients with ST
elevation myocardial infarction
Keywords:
Mean platelet volume
Percutaneous coronary intervention Predictive value of tests
ST elevation myocardial infarction
To the Editor,
We read with great interest the article of Machado et al. [1] about the role of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) in the prediction of adverse events after pri-mary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI). They found that the pa-tients with higher values of MPV had a significantly greater risk of no-reflow phenomenon, procedure complication and in-hospital major adverse cardiovascular events. We would like to comment about this article because we think that there were various factors potentially affected in the MPV results of this study. The authors suggested that MPV was a marker of platelet activa-tion, increased adhesion and platelet aggregaactiva-tion, resulting in thromboembolic events and they explained the relationship be-tween higher MPV and no-reflow in this manner. At the present time, light transmission platelet aggregometry is the gold standard platelet function assay and platelet indices are not used as platelet function tests [2]. Three studies using light transmission aggregom-etry showed there was no correlation between platelet aggregation responses obtained with light transmission platelet aggregometry and platelet indices, including MPV [3e5]. None of the given refer-ences regarding this issue, provided in the article, had investigated the relationship between MPV and platelet function.
One of the most important problems was the non-standard measurement of MPV in this study. Jackson and Carter [6] reported that MPV was dependent on a number of variables, including time of analysis after venipuncture. Ethylenediaminetetraacetic acid (EDTA) causes alterations in plasma membrane permeability and progressive cellular swelling. Therefore, MPV increases over time, when measured with usage of EDTA as an anticoagulant by imped-ance techniques. While different investigators reported varying size changes, MPV increases generally of a maximum of 30% within 5
minutes and then increases an extra 10e15% in the subsequent 2 hours, when EDTA is used as anticoagulant. Maximum deviations in MPV measurements by measurement times varied up to 12.5% in a meta-analysis study that used data from studies about MPV indexed in PubMed in 2012e2015 [7]. As a result, it seems that the timing is very important for the measurement of MPV, and because it was not standardized in this study, data of MPV is very doubtful.
Furthermore, the study had methodological issues. Although it was defined as a prospective cohort study in Materials and methods, the authors indicated in the Discussion that some data were obtained retrospectively. They specified that some subjects were excluded due to the absence of complete blood counts, whereas the evaluation of some complete blood count parameters was the main target of this study. The study had no healthy control group; therefore, the division into groups of NLR and MPV values was determined only according to patients' data. Although it was suggested that MPV had variability according to age and sex, the age and gender distributions of compared groups were not indi-cated in Table 2 [8].
The authors declared that there was some evidence in the liter-ature about the relationship between MPV and adverse events after PCI in patients with STEMI. On the contrary, Noris et al. [8] reported that because of the wide variability of MPV, possibly due to platelet count, sex, age, and ethnicity, as well as the very poor standardiza-tion of the methodologies used for MPV measurement, presently MPV has no role in the diagnosis and defining prognosis of any ac-quired illness in real life.
In conclusion, MPV may not have a role in the prediction of adverse events after PCI in patients with STEMI.
Conflict of interest
The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript. References
[1] G.P. Machado, G.N. de Araujo, C.K. Carpes, M. Lech, S. Mariani, F.H. Valle, L.C.C. Bergoli, S.C. Gonçalves, R.V. Wainstein, M.V. Wainstein, Comparison of neutrophil-to-lymphocyte ratio and mean platelet volume in the prediction of adverse events after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction, Atherosclerosis (2018),https://doi.org/ 10.1016/j.atherosclerosis.2018.05.022.
[2] A. Maclachlan, S.P. Watson, N.V. Morgan, Inherited platelet disorders: insight from platelet genomics using next-generation sequencing, Platelets 28 (2017) 14e19,https://doi.org/10.1080/09537104.2016.1195492.
[3]C.H. Ho, I.H. Chan, The influence of time of storage, temperature of storage,
DOI of original article:https://doi.org/10.1016/j.atherosclerosis.2018.05.022.
Contents lists available atScienceDirect
Atherosclerosis
j o u r n a l h o m e p a g e :w w w . e l s e v i e r . c o m / l o c a t e / a t h e r o s c l e r o s i s
Atherosclerosis 276 (2018) 204e205
https://doi.org/10.1016/j.atherosclerosis.2018.06.875
platelet number in platelet-rich plasma, packed cell, mean platelet volume, he-moglobin concentration, age, and sex on platelet aggregation test, Ann. Hema-tol. 71 (1995) 129e133.
[4] C. Beyan, K. Kaptan, A. Ifran, Platelet count, mean platelet volume, platelet dis-tribution width, and plateletcrit do not correlate with optical platelet aggrega-tion responses in healthy volunteers, J. Thromb. Thrombolysis 22 (2006) 161e164,https://doi.org/10.1007/s11239-006-9014-7.
[5] G. de Luca, M. Verdoia, E. Cassetti, A. Schaffer, G. di Giovine, A. Bertoni, C. di Vito, S. Sampietro, G. Aimaretti, G. Bellomo, P. Marino, F. Sinigaglia, Novara Atherosclerosis Study (NAS) group, Mean platelet volume is not associated with platelet reactivity and the extent of coronary artery disease in diabetic pa-tients, Blood Coagul. Fibrinolysis 24 (2013) 619e624,https://doi.org/10.1097/ MBC.0b013e328360c75a.
[6]S.R. Jackson, J.M. Carter, Platelet volume: laboratory measurement and clinical application, Blood Rev. 7 (1993) 104e113.
[7] C. Beyan, E. Beyan, Were the measurements standardized sufficiently in pub-lished studies about mean platelet volume? Blood Coagul. Fibrinolysis 28 (2017) 234e236,https://doi.org/10.1097/MBC.0000000000000586.
[8] P. Noris, F. Melazzini, C.L. Balduini, New roles for mean platelet volume mea-surement in the clinical practice? Platelets 27 (2016) 607e612, https:// doi.org/10.1080/09537104.2016.1224828.
Cengiz Beyan* Ufuk University Faculty of Medicine, Department of Hematology, Ankara, Turkey Esin Beyan University of Health Sciences, Kecioren Training and Research Hospital, Department of Internal Medicine, Ankara, Turkey
*Corresponding author. Ufuk University Faculty of Medicine,
Department of Hematology, Çankaya, Ankara, Turkey, E-mail addresses:cengizbeyan@etu.edu.tr,
cengizbeyan@hotmail.com,cbeyan@gmail.com(C. Beyan).
24 May 2018 Available online 22 June 2018
