Diagnostic Accuracy of Mean Platelet Volume in the Diagnosis of Acute Coronary Syndromes among Patients with Acute Chest Pain at the Emergency Room of Philippine Heart Center
Introduction. Mean platelet volume (MPV), an index for platelet size, is believed to be associated with acute coronary syndromes (ACS). This study aims to establish the association of MPV and ACS in the local setting and to further evaluate the diagnostic accuracy of MPV in the detection of ACS.
Methodology. Adult patients presented with chest pain seen at the ER were submitted for complete blood count (CBC). The specimen was processed for MPV and platelet count using Beckman-Coulter ACT 5Diff hematology auto-analyzer. Patients were grouped into ACS and non-ACS. Independent t-test was used to determine statistically significant difference between these two groups. Diagnostic cut-off point was determined using the area under the curve.
Results. A total of 150 adult patients were examined for MPV and platelet counts. There was a significant difference of MPV between the two groups at p value <0.0001. The MPV of patients with ACS was increased at 8.3 fL compared to 7.3 fL in patients not diagnosed with ACS. Cut-off points predictive of ACS based on the area under the curve of the ROC curve revealed a significant test (AOC is equal to 0.868 95% CI (0.812-0.924) p = <0.0001). At cut-off point of 8.4 fL, the positive predictive value and specificity for ACS were 100%, sensitivity of 43.6 and a negative predictive value of 46.2. The number of platelets was increased in non-ACS group.
Conclusion. The MPV of acute chest patients diagnosed with ACS was significantly higher compared to patients not diagnosed with ACS. Increased MPV at 8.4 fL was highly specific and predictive of ACS. However, the sensitivity and negative predictive value were low. Platelet count of non-ACS group was increased.
Briggs C. Quality counts: new parameters in blood cell counting. Intl J Lab Hematol. 2009;31(3): 277-97. https://doi.org/10.1111/j.1751-553X.2009.01160.x.
Klovaite J, Benn M, Yazdangar S. High platelet volume and increased risk myocardial infarction: 39 531 participants from the general population. J Thromb and Haemost. 2011;9(1):49-56. https://doi.org/10.1111/j.1538-7836.2010.04110.x.
Mercan R, Demir C, Dilek I, Asker M, Atmaca M. Mean platelet volume in acute coronary syndrome. Van Tip Dergisi. 2010;17:89-95.
Lippi G, Filippozzi L, Salvagno GL, Montagnana M, Franchini M, Guidi GC, et al. Increased mean platelet volume participants with acute coronary syndromes. Arch Pathol Lab Med. 2009;133(9):1441-3. https://doi.org/10.1043/1543-2165-133.9.1441. PMID: 19722752.
Yilmaz MB, Cihan GC, Guray Y, Guray U, Kisacik HL, et al. Role of mean platelet volume in triagging acute coronary syndromes. J Tromb Thrombolysis. 2008;26(1)49-54. https://doi.org/10.1007/s11239-007-0078-9.
Endler G, Klimesch A, Sunder-Plassmann H, Schillinger M, Exner M, et al. Mean platelet volume in an independent risk factor for myocardial infarction but not for coronary artery disease. Brit J Haematol. 2002;117(2):399-404. https://doi.org/10.1046/j.1365-2141.2002.03441.x.
Khandekar MM, Khurana AS, Deshmukh SD, Kakrani AL, Katdare AD. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: An Indian Scenario. J Clin Path. 2006;59(2):146-9. PMID: 16443728.
Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. In Henry’s clinical diagnosis and management by laboratory methods. 22nd ed, ch. 30, pp. 509-535.e2. Philadelphia: Elsevier Saunders, 2011.
Lamorena N, Torres MCD. Clinical features of emergency department patients presenting with symptoms suggestive of acute coronary syndrome: The Philippine Heart Center Experience 2004. Philippine Heart Center.
Coulter® HmX hematology analyzer with autoloader: operator’s guide. CE-Beckmann Coulter, Inc. Fullertone, Ca 92835, 2003.
Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guidelines update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction-2012: summary article. Circulation. 2002;106: 1883-1900. https://doi.org/10.1161/01.CIR.0000037106.76139.53.
Copyright (c) 2016 Philippine Journal of Pathology
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Philippine Journal of Pathology is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Based on works made open access at http://philippinejournalofpathology.org