Usefulness of white blood cell count to mean platelet volume ratio in predicting short term, 30 days major adverse cardiac events in patients presenting with acute coronary syndrome
Keywords:Acute coronary syndrome, Major adverse cardiac event, White blood cell to mean platelet volume ratio
Background: The role of white blood cell (WBC) to mean platelet volume (MPV) ratio (WMR) in predicting short-term major adverse cardiac events (MACE) in patients presenting with acute coronary syndrome (ACS) has not been studied extensively. We aimed to determine whether WMR can predict short-term (30 days) MACE in ACS patients.
Methods: This hospital-based prospective cohort study was undertaken at a tertiary-care teaching hospital in India from January 2018 to December 2018. Fifty patients presenting with ACS to undergo primary percutaneous intervention were evaluated for WMR and short-term MACE.
Results: Receiver operating characteristic (ROC) curve showed cut-off value of WMR as 1059 with area under the ROC curve of 0.825 (SE=0.074; 95% CI: 0.679-0.971; p=0.001). MACE was noted in 10 patients (20%) and mortality in 4 patients (8%). WMR with cut-off value of 1059 was significant and highly accurate in predicting MACE (diagnostic accuracy: 72%, sensitivity: 80%, specificity: 70%, positive predictive value: 40%, negative predictive value: 93.33%, p=0.016, and positive likelihood ratio: 2.67, negative likelihood ratio: 0.29). Risk of short-term MACE increases with higher respiratory rate, creatine kinase and creatine kinase myocardial band, alanine aminotransferase, WBC count, neutrophils, neutrophil to lymphocyte ratio, total bilirubin, aspartate aminotransferase, lymphocytes, uric acid, lower SBP, DBP, Troponin I, red blood cell count, and ejection fraction and clinical presentation such as, palpitations, sweating, giddiness, loss of consciousness, higher Killip class, and diagnosis of inferior wall myocardial infarction.
Conclusions: Higher WMR values on admission (≥1059) are associated with worse short-term outcomes in patients with ACS and independently predict short-term MACE.
Gupta R, Joshi P, Mohan V, Reddy K, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart. 2008;94(1):16-26.
Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349(9061):1269-76.
Reddy KS. Cardiovascular diseases in India. World health statistics quarterly Rapport trimestriel de statistiques sanitaires mondiales 1993;46(2):101-7.
Nayak MT, Kamath V. Outcome of endoscopic third ventriculostomy: Analysis of first 23 cases. Inter J Adv Med. 2002;2(2):94-9.
Libby P. Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med. 2013;368:2004-13.
Dehghani MR, Rezaei Y, Taghipour-Sani L. Superiority of total white blood cell count over other leukocyte differentials for predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome. Biomarkers. 2014;19(5):378-84.
Rechciński T, Jasińska A, Foryś J, Krzemińska-Pakuła M, Wierzbowska-Drabik K, Plewka M, et al. Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention. Cardiol J 2013;20(5):491-8.
Dehghani MR, Rezaei Y, Fakour S, Arjmand N. White blood cell count to mean platelet volume ratio is a prognostic factor in patients with non-ST elevation acute coronary syndrome with or without metabolic syndrome. Korean Circ J 2016;46(2):229-38.
Dehghani MR, Rezaei Y, Taghipour-Sani L. White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome. Cardiol. J 2015;22(4):437-45.
Adam AM, Rizvi AH, Haq A, Naseem R, Rehan A, Shaikh AT, et al. Prognostic value of blood count parameters in patients with acute coronary syndrome. Indian Heart J. 2018;70(2):233-40.
Mello BHGd, Oliveira GBF, Ramos RF, Lopes BBC, Barros CBS, Carvalho EdO, et al. Validation of the Killip-Kimball classification and late mortality after acute myocardial infarction. Arq Bras Cardiol. 2014;103(2):107-17.
Raphael C, Briscoe C, Davies J, Whinnett ZI, Manisty C, Sutton R, et al. Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure. Heart. 2007;93(4):476-82.
Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. Eur Heart J. 2007;28(20):2525-38.
Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's principles of internal medicine: McGraw-Hill Companies; 2015.
Estévez-Loureiro R, Salgado-Fernández J, Marzoa-Rivas R, Barge-Caballero E, Pérez-Pérez A, Noriega-Concepción V, et al. Mean platelet volume predicts patency of the infarct-related artery before mechanical reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Thromb Res. 2009;124(5):536-40.
Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14(1):28-32.
Goncalves SC, Labinaz M, Le May M, Glover C, Froeschl M, Marquis JF, et al. Usefulness of mean platelet volume as a biomarker for long-term outcomes after percutaneous coronary intervention. Am J Cardiol. 2011;107(2):204-9.
Shah B, Oberweis B, Tummala L, Amoroso NS, Lobach I, Sedlis SP, et al. Mean platelet volume and long-term mortality in patients undergoing percutaneous coronary intervention. Am J Cardiol. 2013;111(2):185-9.
D'Ascenzo F, Biondi-Zoccai G, Moretti C, Bollati M, Omedè P, Sciuto F, et al. TIMI, GRACE and alternative risk scores in Acute Coronary Syndromes: a meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients. Contemp Clin Trials. 2012;33(3):507-14.
Brkovic V, Dobric M, Beleslin B, Giga V, Vukcevic V, Stojkovic S, et al. Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiovasc Imaging. 2013;29(6):1215-28.
Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45(10):1638-43.
Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: A TACTICS-TIMI 18 substudy. J Am Coll Cardiol. 2002;40(10):1761-8.
Huang G, Zhong X, Zhong B, Chen Y, Liu Z, Su L, et al. Significance of white blood cell count and its subtypes in patients with acute coronary syndrome. Eur J Clin Invest. 2009;39(5):348-58.
He J, Li J, Wang Y, Hao P, Hua Q. Neutrophil-to-lymphocyte ratio (NLR) predicts mortality and adverse-outcomes after ST-segment elevation myocardial infarction in Chinese people. Int J Clin Exp Pathol. 2014;7(7):4045.
Barron HV, Harr SD, Radford MJ, Wang Y, Krumholz HM. The association between white blood cell count and acute myocardial infarction mortality in patients≥ 65 years of age: findings from the cooperative cardiovascular project. J Am Coll Cardiol. 2001;38(6):1654-61.
Cicek G, Acikgoz SK, Yayla C, Kundi H, Ileri M. White blood cell count to mean platelet volume ratio: A novel and promising prognostic marker for ST-segment elevation myocardial infarction. Cardiol J. 2016;23(3):225-35.