Hasan Aydın BAŞ, Ali BAĞCI, Fatih AKSOY

Usefulness of Mean Platelet Volume and Neutrophil-To-Lymphocyte Ratio for Development of Atrial Fibrillation After Acute Myocardial Infarction

Amaç: Atriyal fibrilasyon (AF), ST yükselmiş miyokard infarktüsünü (STEMI) takiben en sık görülen supraventriküler aritmidir. Ortalama trombosit hacmi (MPV) trombosit aktivasyonunun ve fonksiyonunun bir göstergesidir. Ortalama trombosit hacmi, gelecekteki inme ve miyokard enfarktüsü için bağımsız bir risk faktörü olarak belirlenmiştir. Nötrofil / lenfosit oranı (NLR) tespiti, inflamatuar durumu değerlendirmek için hızlı ve basit bir yöntem olup son zamanlarda kardiyovasküler risk ve AF için bir ön gördürücü olarak saptanmıştır. Bu çalışmanın amacı, STEMI sonrası AF gelişiminde NLR ve MPV düzeyleri arasındaki olası bir ilişkiyi değerlendirmektir. Yöntem: Bu prospektif çalışmaya, koroner bakım ünitesine başvuran, akut STEMI' li 743 hasta dahil edildi. Hastalar AF olan ve olmayan iki gruba ayrıldı. AF gelişimin ön gördürücüleri çok değişkenli regresyon analizi ile belirlendi. Bulgular: STEMI ile başvuran toplam 743 hastanın 82 sinde (%11) AF gelişti. Ortalama trombosit hacmi ve NLR, AF' gelişen hastalarda AF gelişmeyen hastalara göre anlamlı derecede yüksekti (sırasıyla p <0,001). Çok değişkenli regresyon analizi sonuçları, yaş [Odds ratio (OR)=1,03; %95 Güven Aralığı (GA)=1,01-1,05; p=0,001), ejeksiyon fraksiyonu (OR=0,95; %95 GA = 0,93-0,98; p <0,001), MPV (OR=1,738; % 95 GA = 1,29-2,33; p<0,001), NLR (OR=1,08; %95, GA=1,01-1,15; p=0,025) ve hastane öncesi anjiyotensinojen dönüştürücü enzim blokerleri kullanımı (OR=3.04; % 95 GA=1,22-7,54; p = 0,017), STEMI hastalarında AF gelişimi ile ilişkiliydi. Sonuç: Bu çalışma, MPV ve NLR' nin STEMI hastalarda AF gelişimi ile ilişkili olduğunu ve AF' nin diğer bağımsız ön gördürücülerinin ise yaş ve ejeksiyon fraksiyonunu olduğunu göstermiştir.

Anahtar Kelimeler:

Miyokard infarktüsü, atriyal fibrilasyon, ortalama trombosit hacmi, nötrofil lenfosit oranı

Usefulness of mean platelet volume and neutrophil-to-lymphocyte ratio for development of atrial fibrillation after acute myocardial infarction

Objective: Atrial fibrillation (AF) is the most common supraventricular arrhythmia following ST elevated myocardial infarction (STEMI). Mean platelet volume (MPV) is an indicator of platelet activation and function. Mean platelet volume has been identified as an independent risk factor for future stroke and myocardial infarction. The neutrophil-to-lymphocyte ratio (NLR), fast and easy method for detecting inflammatory status, have been recently explored as a predictor for cardiovascular risk and AF. The aim of the present study was to evaluate a possible relationship between NLR and MPV levels on development of AF after STEMI.Methods: This prospective study consisted of 743 patients with acute STEMI who were admitted to coronary care unit. Patients were divided into two groups, patients with and without AF. Predictors of AF were determined by multivariate regression analysis.Results: From a total of 743 patients presenting with STEMI, 82 (11%) developed AF. Mean platelet volume and NLR was significantly higher in patients with AF compared to without AF (p<0.001, respectively). Multivariate regression analysis results showed that, age [Odds Ratio (OR)=1.03; 95% Confidence Interval (CI)=1.01-1.05; p=0.001), ejection fraction (OR=0.95; 95% CI=0.93-0.98; p<0,001), MPV (OR=1.738; 95% CI=1.29-2.33; p<0.001), NLR (OR=1.08; 95% CI=1.01-1.15; p=0,025) and previous angiotensinogen converting enzyme blockers (OR=3.04; 95% CI=1.22-7.54; p=0,017) using were associated with development of AF in patients with acute STEMI. Conclusions: This study showed that, MPV and NLR were associated with the development of AF in patients presenting STEMI, other independent predictors of AF included age, and ejection fraction.

Keywords:

Myocardial infarction, atrial fibrillation, mean platelet volume, neutrophil-to-lymphocyte ratio,

PDF

___

1. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European heart journal. 2010;31(19):2369-429.
2. Asanin M, Perunicic J, Mrdovic I, Matic M, Vujisic-Tesic B, Arandjelovic A, et al. Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction. European journal of heart failure. 2005;7(4):671-6.
3. Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ, et al. Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation. 2000;101(9):969-74.
4. Park Y, Schoene N, Harris W. Mean platelet volume as an indicator of platelet activation: methodological issues. Platelets. 2002;13(5-6):301-6.
5. Kamath S, Blann AD, Lip GY. Platelet activation: assessment and quantification. European heart journal. 2001;22(17):1561-71.
6. Ha SI, Choi DH, Ki YJ, Yang JS, Park G, Chung JW, et al. Stroke prediction using mean platelet volume in patients with atrial fibrillation. Platelets. 2011;22(6):408-14.
7. Mathur A, Robinson MS, Cotton J, Martin JF, Erusalimsky JD. Platelet reactivity in acute coronary syndromes: evidence for differences in platelet behaviour between unstable angina and myocardial infarction. Thrombosis and haemostasis. 2001;85(6):989-94.
8. Colkesen Y, Acil T, Abayli B, Yigit F, Katircibasi T, Kocum T, et al. Mean platelet volume is elevated during paroxysmal atrial fibrillation: a marker of increased platelet activation? Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 2008;19(5):411-4.
9. Coban E, Ozdogan M, Yazicioglu G, Akcit F. The mean platelet volume in patients with obesity. International journal of clinical practice. 2005;59(8):981-2.
10. Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. The American journal of cardiology. 2010;106(4):470-6.
11. Corriere T, Di Marca S, Cataudella E, Pulvirenti A, Alaimo S, Stancanelli B, et al. Neutrophil-to-Lymphocyte Ratio is a strong predictor of atherosclerotic carotid plaques in older adults. Nutrition, metabolism, and cardiovascular diseases : NMCD. 2018;28(1):23-7.
12. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. European heart journal. 2009;30(9):1038-45.
13. Saczynski JS, McManus D, Zhou Z, Spencer F, Yarzebski J, Lessard D, et al. Trends in atrial fibrillation complicating acute myocardial infarction. The American journal of cardiology. 2009;104(2):169-74.
14. Wong CK, White HD, Wilcox RG, Criger DA, Califf RM, Topol EJ, et al. Significance of atrial fibrillation during acute myocardial infarction, and its current management: insights from the GUSTO-3 trial. Cardiac electrophysiology review. 2003;7(3):201-7.
15. Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. Journal of the American College of Cardiology. 1997;30(2):406-13.
16. Pizzetti F, Turazza FM, Franzosi MG, Barlera S, Ledda A, Maggioni AP, et al. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data. Heart. 2001;86(5):527-32.
17. Martin JF, Bath PM, Burr ML. Influence of platelet size on outcome after myocardial infarction. Lancet. 1991;338(8780):1409-11.
18. Dogan A, Aksoy F, Icli A, Arslan A, Varol E, Uysal BA, et al. Mean platelet volume is associated with culprit lesion severity and cardiac events in acute coronary syndromes without ST elevation. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 2012;23(4):324-30.
19. Unal EU, Ozen A, Kocabeyoglu S, Durukan AB, Tak S, Songur M, et al. Mean platelet volume may predict early clinical outcome after coronary artery bypass grafting. Journal of cardiothoracic surgery. 2013;8(1):91.
20. Klovaite J, Benn M, Yazdanyar S, Nordestgaard BG. High platelet volume and increased risk of myocardial infarction: 39,531 participants from the general population. Journal of thrombosis and haemostasis : JTH. 2011;9(1):49-56.
21. Erdogan D, Tayyar S, Icli A, Uysal BA, Varol E, Ozaydin M, et al. Elevated mean platelet volume is associated with impaired coronary microvascular function in patients with idiopathic dilated cardiomyopathy. Platelets. 2012;23(3):177-83.
22. Choudhury A, Chung I, Blann AD, Lip GY. Platelet surface CD62P and CD63, mean platelet volume, and soluble/platelet P-selectin as indexes of platelet function in atrial fibrillation: a comparison of "healthy control subjects" and "disease control subjects" in sinus rhythm. Journal of the American College of Cardiology. 2007;49(19):1957-64.
23. Erdem K, Ayhan S, Ozturk S, Bugra O, Bozoglan O, Dursin H, et al. Usefulness of the mean platelet volume for predicting new-onset atrial fibrillation after isolated coronary artery bypass grafting. Platelets. 2013.
24. Karatas MB, Canga Y, Ipek G, Ozcan KS, Gungor B, Durmus G, et al. Association of admission serum laboratory parameters with new-onset atrial fibrillation after a primary percutaneous coronary intervention. Coronary artery disease. 2016;27(2):128-34.
25. Arslan A, Ozaydin M, Aksoy F, Arslan B, Bas HAB, Erdogan D, et al. Association between the use of renin-angiotensin system blockers and development of in-hospital atrial fibrillation in patients with ST-segment elevation myocardial infarction. Medicina. 2016;52(2):104-9.