Predictive Value Of Mean Platelet Volume On Anti-platelet Therapy Resistance In Patients Treated With High-risk Percutaneous Coronary Intervention

Objective Studies confirmed that the antiplatelet drug resistance increases the risk of stent thrombosis and adverse cardiovascular events.However,although there were already a variety of platelet function test methods can evaluate the antiplatelet drug resistance,they were complicated,time-consuming and expensive.Therefore,it is necessary to find a quick,easy and cheap index to identify which patients may appear antiplatelet drug resistance.So,this study mainly explore the relationship between the initial mean platelet volume(MPV)levels and the resistance to anti-platelet therapy(including aspirin and clopidogrel),and analyze the predictive value of MPV on the resistances to aspirin and clopidogrel in patients treated with high-risk PCI.Methods 74 patients with acute coronary syndrome(ACS)who had been subjected to high-risk coronary intervention and dual-antiplatelet therapy(DAPT)were selected in the Coronary Care Units(CCU)of Anhui Provincial Hosiptal from November 2014 to January 2016.Exlusion criteria were pregnant women,patients used anticoagulant drugs 2 weeks before admission,patients with a history of blood transfusion in a month,and blood system disease,malignant tumor,rheumatoid immune system disease and severe infectious disease patients,as well as patients who could not used the DAPT for long time.Thromboelastograph(TEG)platelet mapping was conducted to detect platelet function.Resistances to aspirin and clopidogrel were defined as the arachidonic acid(AA)-induced inhibition of platelet aggregation(IPA)was less than 50% and the adenosine diphosphate(ADP)-induced IPA was less than 30%,respectively.All the patients in this study could be divided into different groups,such as Clopidogrel Resistance(CR)and Clopidogrel Sensitive(CS)groups,Aspirin Resistance(AR)and aspirin sensitive(AS)groups.MPV was measured by routine blood test.The clinical data of all the patients would be analyzed.Results The prevalence of CR and AR were 36.5%(n=27)and 28.4%(n=21),respectively.MPV was higher in both CR and AR group than that in CS and AS group [(11.54±0.89)f L vs.(10.05±1.09)f L,(11.29±1.03)f L vs.(10.32±1.23)f L,both P<0.05].The Univariate analysis and Logistic regression method were employed,and the results showed that the initial MPV was an independent predictor in both AR and CR groups(P<0.001;OR=4.170,95%CI: 1.971-8.823,P<0.001).According to the result of receiving operating characteristic(ROC)curve,for CR and AR group,the best cut-point of MPV was 9.95 f L and 10.65 f L,the sensitivity and specificity for differentiating between the CR and CS were 100.0% and 55.3% and for AR and AS were 81.0% and 37.3%,respectively(95%CI : 0.779-0.942,P<0.01;95%CI :0.609-0.856,P=0.002).Conclusions High-level of MPV is an independent predictors for both CR and AR in ACS patients treated with high-risk coronary intervention.