Effect Of Mean Platelet Volume On Prognosis Of Patients With Acute Myocardial Infarction And Evaluation Of Drug Intervention

BACKGROUND Influenced by population growth and aging,the total number of cardiovascular diseases worldwide,especially in some developed countries,has been increasing year by year since the 1990 s.Despite improvements in prevention strategies and health interventions in recent years,mortality rates have declined in recent years,but at a slow rate.In China,ischemic heart disease and stroke are the main causes of death nationwide,and these two major causes of death are also the main causes of disease burden.According to statistics in recent years,coronary heart disease has become the main cause of death of urban and rural residents,and the mortality rate in rural areas has increased significantly,exceeding that in urban areas,which also brings a huge medical and economic burden to the country and people.Acute myocardial infarction,one of the most common and serious coronary heart disease,has become the most common cause of death at present.In recent years,acute myocardial infarction(AMI)has made great progress in drugs and percutaneous coronary intervention(PCI),but its prognosis is still poor.Therefore,early identification of risk factors affecting the prognosis,intervention and treatment of AMI is extremely important.In recent years,people have been devoted to looking for more new factors affecting the prognosis of patients with acute myocardial infarction(AMI),in order to improve the prognosis of patients with early intervention.Average platelet volume has become a new research hotspot in recent years.As a part of the whole blood count,the average platelet volume has been widely used in clinical practice,which does not require additional costs and reduces medical costs.The complete blood count test is easy to obtain,simple and cheap,and can be carried out in primary hospitals.These advantages make mean platelet volume a predictor of the course and prognosis of patients with acute myocardial infarction.Therefore,the purpose of this study was to observe the relationship between mean platelet volume and prognosis in patients with acute ST-segment elevation myocardial infarction undergoing first PCI,and to observe the effect of drug intervention on mean platelet volume.METHODS From January 2016 to June 2019,319 patients who were hospitalized for STEMI for the first time in Ma ’anshan Clinical College and underwent emergency PCI were enrolled consecutively,according to the level of MPV at admission,the patients were divided into two groups: the increased MPV group(MPV≥ 12.5FL,171 cases)and the normal MPV group(MPV < 12.5FL,148 cases).The incidence of major cardiovascular adverse events(MACE),prehospital medication,intraoperative and postoperative medication for PCI,and the effects of different drugs on MPV were observed in the increased MPV group and the normal MPV group..According to perioperative drug use,they were further divided into 3 subgroups: atorvastatin load group(69 cases)(double anti-drug and atorvastatin 80 mg orally before PCI,other treatments were the same as the control group)and control group(219 cases);There were 94 cases in clopidogrel group and 125 cases in ticagrelor group: the two groups had the same treatment except for the difference of dual antidrug;31 patients in tirofiban group(intraoperative intracoronary injection of tirofiban 5ug/kg,postoperative tirofiban 0.075ug·kg-1·min-1 continuous intravenous pumping for 24-48h)and 46 patients in control group were observed.The changes of mean platelet volume between groups before and after treatment were compared.RESULTS Follow-up showed a higher incidence of major cardiovascular adverse events(MACE)in the increased MPV group than in the normal MPV group,which were heart failure(P=0.041 < 0.05)and postinfarct angina pectoris(P=0.033 <0.05).Both univariate and multivariate regression analyses showed that increased MPV on admission was an independent risk factor for major cardiovascular adverse events(MACE)(P=0.049,OR=1.638).Compared with the normal MPV group,the use rate of statins and antiplatelet drugs such as clopidogrel/ticagrelor was lower in the increased MPV group before onset,and there was no statistically significant difference in the use rate of other drugs between the two groups(P >0.05)..Subgroup analysis showed that statins can more effectively reduce the MPV PCI preoperative load(P < 0.001),on behalf of Greg los group MPV reduced obviously in the clopidogrel group(P < 0.05),while for the group and the control group had Δ MPV no statistically significant difference(P > 0.05).CONCLUSION The results of this study suggest that increased MPV(MPV≥12.5f L)is predictive of prognosis in patients with acute ST-segment elevation myocardial infarction after the first emergency percutaneous coronary intervention(PCI),and that increased MPV(MPV≥12.5f L)is associated with an increased risk of MACE.Pretreatment with atorvastatin(80mg)before surgery can significantly reduce the MPV value,which has a high safety and provides a reference for clinical treatment.In addition,subgroup analysis found that the P2Y12 receptor inhibitor(clopidogrel/ticagrelor)may also have a role in reducing MPV,and the novel P2Y12 receptor inhibitor(ticagrelor)was even more effective.