The Correlation Between Red Blood Cell Distribution Width And Mean Platelet Volume With Acute ST-segment Elevation Myocardial Infarction And Thrombolytic Outcome

Background and ObjectiveAcute ST-segment elevation myocardial infarction(STEMI)is the most serious and lethal clinical type of coronary heart disease.Early diagnosis and early reperfusion therapy are recommended by current guidelines and have been proved to be the most effective treatment in clinical practice.Thrombolysis in reperfusion therapy is the most direct and simple way to achieve this measure.Early judgment of STEMI and success of thrombolysis,that is,whether effective reperfusion can be achieved,is directly related to the clinical outcome of patients.Therefore,it is very important to evaluate the occurrence of STEMI and success of thrombolysis.Coronary angiography(CAG)is the "golden standard" for evaluating the success of thrombolysis.However,CAG is an invasive examination.Due to the limitations of various conditions,CAG can not be used early after thrombolysis in STEMI patients.Therefore,it is very important to seek more and more effective non-invasive examinations to evaluate the success of thrombolysis.In clinic,non-invasive methods for assessing coronary artery recanalization after thrombolytic therapy include 50%reduction of ST segment elevation in ECG within 2 hours?disappearance of chest pain symptoms within 2 hours after thrombolytic therapy?reperfusion arrhythmia within 2 hours,and early peak CK-MB in serum.In recent years,studies have shown that red blood cell distribution width(RDW)and mean platelet volume(MPV)are related to the occurrence and development of coronary heart disease,but there are few reports on the relationship between RDW?MPV with STEMI and thrombolytic outcomes.The purpose of this study was to investigate the correlation between erythrocyte distribution width(RDW)?mean platelet volume(MPV)with acute ST-segment elevation myocardial infarction(STEMI)and thrombolytic outcomes,and to provide a new reference index for evaluating the occurrence of acute ST-segment elevation myocardial infarction and the success of thrombolytic therapy.Materials and MethodsFrom December 2015 to December 2018,STEMI was diagnosed in the Department of Cardiology of Minquan People's Hospital.Patients who had received thrombolytic therapy with Retepiase(rPA)for injection(Ruitongli)after admission and had undergone coronary angiography were selected.According to the results of coronary angiography,the patients were divided into two groups:the successful group and the failed group.Meanwhile,patients with the same number of STEMI patients included in our hospital with normal physical examination results during the same period were selected.A total of 135 STEMI patients were enrolled in this study,including 96 males and 39 females.The average age was(59.62± 10.73),of which 86 cases were successfully treated with thrombolysis,with a success rate of 63.70%.General data of age?sex?history of hypertension?diabetes mellitus and smoking were collected.After admission,the height and weight of patients were measured,and body mass index and body surface area were calculated.Blood biochemical indexes(blood sugar?TG?HDL-C?uric acid?hemoglobin?RBC?PLT?TC?LDL-C?RDW?PDW?MPV?WBC)?echocardiography?blood pressure and electrocardiogram were collected after admission.The GRACE score was calculated.The data were analyzed by SPSS22.0 software.The relationship between RDW?MPV and STEMI was analyzed by logistic regression.The diagnostic value of RDW?MPV for STEMI was evaluated by ROC curve.The relationship between RDW?MPV and thrombolytic outcomes was analyzed by logistic regression.The diagnostic value of RDW?MPV for thrombolytic outcomes of STEMI patients was evaluated by ROC curve.Test level:a=0.05,P<0.05 has statistical significance.ResultsThere were no significant differences in age?sex?history of hypertension?history of diabetes mellitus?systolic blood pressure?diastolic blood pressure?heart rate?blood sugar?BMI?TG?HDL-C?uric acid?hemoglobin?RBC and PLT between STEMI group and control group(P>0.05).There were significant differences in smoking history?TC?LDL-C?RDW?PDW?MPV and WBC between the two groups(P<0.05).There were no significant differences in age?sex?heart rate?systolic blood pressure?diastolic blood pressure?BMI?smoking history?hypertension history?diabetes mellitus?vessel branch number?lesion location?TC?TG?LDL-C?HDL-C?uric acid?blood sugar?WBC?hemoglobin and PLT between the two groups(all P>0.05).There were significant differences in LVEF?PDW?RDW?MPV and GRACE scores(all P<0.05).The difference of PD W,RDW and MPV before and after thrombolysis was statistically significant(P<0.05).Multivariate stepwise regression analysis showed that RDW(OR=1.251,95%ci:1.165-1.343,P<0.001)?PDW(OR=1.222,95%ci:1.042-1.436,P<0.001)and MPV(OR=1.407,95%ci:1.093?2.145,P=0.003)were all predictors of STEMI.Meanwhile,RDW(OR=1.258,95%ci:1.095-1.444,P<0.001)?MPV(OR=1.514,95%ci:1.055-2.1 72,P=0.024)and GRACE scores(OR=1.226,95%ci:1.119?1.530,P<0.001)were all predictors of thrombolysis failure.RDW predicted that the area under the curve of STEMI was 0.772(95%CI:0.665-0.775,P<0.001),Yoden index was 0.3556,and Cut-off was 13.11.At this time,the sensitivity and specificity were 77.04%and 58.52%.MPV predicted the area under the curve of STEMI was 0.658(95%CI:0.598-0.714,P<0.001),Yoden index was 0.2815,Cut-off was 11.31,and the sensitivity and specificity were 74.55%and 53.60%.The area under the curve of RDW predicting thrombolytic failure was 0.686(95%CI:0.600-0.763,P<0.001),Yoden index was 0.3598,Cut-off was 13.19,and the sensitivity and specificity were 60.47%and 75.51%,respectively.MPV predicted the area under the curve of thrombolytic failure was 0.687(95%CI:0.602-0.764,P=0.001),Yoden index was 0.3446,Cut-off was 12.47,the sensitivity and specificity were 66.31%and 68.15%.Conclusion1.RDW and MPV was independent predictors of STEMI.2.RDW and MPV was independent predictors of thrombolytic failure in STEMI patients.