European Journal of Cardiovascular Medicine

Acute ST‑segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality worldwide despite advances in reperfusion therapy and secondary prevention [1]. Early risk stratification is crucial to guide immediate management and anticipate adverse outcomes. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a validated tool incorporating age, blood pressure, heart rate, Killip class, renal function, prior coronary disease, and time to treatment to estimate risk of death and ischemic events [2]. However, conventional scores do not capture all pathophysiological mechanisms, such as microvascular damage and infarct progression [3].Platelets are central to coronary thrombosis, with plaque rupture followed by platelet activation and aggregation driving thrombus formation in acute coronary syndromes [4]. Mean platelet volume (MPV), a measure of platelet size, reflects platelet reactivity and activation. Larger platelets are more thrombogenic due to increased metabolic and enzymatic activity, denser granules, and greater expression of glycoprotein IIb/IIIa and P‑selectin [5]. Studies have shown higher MPV in STEMI patients compared to NSTEMI, stable angina, or non-cardiac chest pain, highlighting its diagnostic and prognostic potential [6,7]. Even with timely reperfusion, many STEMI patients develop microvascular dysfunction or no‑reflow, partly driven by platelet hyperactivity [8]. Elevated MPV has been associated with larger infarcts, impaired reperfusion, higher in‑hospital and long-term mortality, and major adverse cardiovascular events (MACE) [9,10]. Despite this evidence, data from North‑east India are limited, and the correlation of MPV with TIMI score at presentation is not well studied. This study aims to evaluate the prognostic significance of admission MPV in STEMI patients and its correlation with TIMI risk score, potentially providing an inexpensive, readily available tool for early risk stratification.

The primary aim of this observational study was to evaluate the prognostic utility of Mean Platelet Volume (MPV) in patients with Acute ST-elevation Myocardial Infarction (STEMI) in a North-east Indian population. The specific objectives were to determine the association of MPV levels with the presence of STEMI by comparing them with matched healthy controls, and to systematically investigate its correlation with the TIMI risk score to ascertain if higher MPV values are associated with greater disease severity and predicted adverse outcomes.

Study design: Hospital based prospective observational study. Place of study: Department of General medicine and Department of Cardiology, Silchar medical college and hospital, Silchar, Assam. Period of study: 6 months (1st march 2022 to 31st September 2022) Sample size: 100 cases of acute STEMI and 100 age and sex matched controls. Inclusion Criteria: • Age ≥18 years. • Confirmed diagnosis of acute STEMI based on clinical history, ECG changes, and cardiac biomarkers. Exclusion Criteria: • History of prior myocardial infarction or coronary revascularization. • Hematological disorders, chronic liver or renal disease, inflammatory or autoimmune disorders. • Use of medications affecting platelet function (except standard STEMI treatment). • Pregnant or lactating women. Study Variable: • Mean Platelet Volume (MPV) • STEMI diagnosis • TIMI Risk Score categories • Killip Class classification • Age • Sex • Hypertension • Diabetes Mellitus • Smoking status • Dyslipidemia Statistical Analysis: For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and Graph Pad Prism (version 5). Numerical variables were summarized using means and standard deviations, while Data were entered into Excel and analyzed using SPSS and Graph Pad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

Table 1: Baseline Demographic Characteristics

Table 2: Association between Cardiovascular Risk Factors

Table 3: Distribution of Mean Platelet Volume (MPV) Comparison

Table 4: TIMI Risk Score Distribution

Table 5: Correlation of MPV with TIMI Score

Table 6: MPV vs Killip Class

Table 7: MPV and outcomes of acute STEMI cases (n = 100)

Table 2 shows the distribution of cardiovascular risk factors among STEMI cases and controls. Hypertension was present in 55 STEMI patients (55%) compared to 40 controls (40%), which was statistically significant (p = 0.04). Diabetes mellitus was observed in 38 STEMI cases (38%) versus 22 controls (22%) with a significant difference (p = 0.02). Smoking was reported in 46 patients with STEMI (46%) and 28 controls (28%), also showing a significant association (p = 0.01). Dyslipidemia was present in 52 STEMI cases (52%) compared to 35 controls (35%), with the difference being statistically significant (p = 0.03). Table 3 presents the comparison of mean platelet volume (MPV) between STEMI cases and controls. The mean MPV in STEMI patients was 10.2 ± 1.1 fL, which was significantly higher than that in the control group, where the mean MPV was 8.5 ± 0.9 fL (p < 0.001). This indicates that patients with STEMI had significantly elevated platelet activity compared to controls.

Table 4 In our study of 100 STEMI patients, the majority fell into the intermediate TIMI risk category, with 46 patients (46%) scoring between 3 and 4. The low-risk category (0–2) included 28 patients (28%), while 26 patients (26%) were classified as high risk (5–7). Mean platelet volume (MPV) was significantly associated with TIMI risk scores, increasing progressively across categories: 9.5 ± 0.8 fL in the low-risk group, 10.1 ± 0.9 fL in the intermediate-risk group, and 11.0 ± 1.0 fL in the high-risk group, with a p-value of <0.001, indicating a strong correlation between higher MPV and elevated TIMI risk scores.

Correlation of MPV with TIMI Score is shown in Table 5. A strong positive correlation was observed between mean platelet volume (MPV) and TIMI risk score, with a correlation coefficient (r) of 0.62, which was statistically significant (p < 0.001). This indicates that higher MPV values were associated with higher TIMI risk scores among STEMI patients.

MPV and Killip Class shown in Table 6. The relationship between mean platelet volume (MPV) and Killip class was evaluated in 100 STEMI patients. MPV values increased progressively with higher Killip classes: 9.8 ± 0.9 fL in Class I (n=45, 45%), 10.3 ± 1.0 fL in Class II (n=32, 32%), 10.8 ± 1.1 fL in Class III (n=18, 18%), and 11.2 ± 1.2 fL in Class IV (n=5, 5%). This trend was statistically significant (p = 0.002), suggesting that elevated MPV is associated with worsening clinical severity as indicated by higher Killip classes.

In this cohort of 100 patients with acute STEMI, higher Mean Platelet Volume (MPV) was significantly associated with adverse clinical outcomes. Patients who developed cardiogenic shock requiring inotropic support (n = 18, 18%) had a mean MPV of 11.1 ± 1.2 fL, significantly higher than those without shock (10.2 ± 1.0 fL, p = 0.004). Similarly, patients with reduced left ventricular ejection fraction (<50%) on echocardiography (n = 14, 14%) had elevated MPV (11.2 ± 1.1 fL) compared to those with preserved EF (10.1 ± 1.0 fL, p = 0.006). The need for ICU admission (n = 22, 22%) was also associated with higher MPV (11.1 ± 1.1 fL vs 10.1 ± 1.0 fL, p = 0.01). Notably, in-hospital mortality (n = 9, 9%) occurred predominantly in patients with elevated MPV (11.3 ± 1.2 fL) compared to survivors (10.3 ± 1.0 fL, p = 0.003). Additionally, patients who experienced complications during the hospital stay, such as arrhythmias, left ventricular aneurysm, or AV block (n = 11, 11%), had higher MPV (11.2 ± 1.1 fL) than those without complications (10.3 ± 1.0 fL, p = 0.008). Overall, elevated MPV was significantly associated with worse outcomes, including cardiogenic shock, reduced LVEF, ICU admission, in- hospital mortality, and in-hospital complications, highlighting its potential role as a prognostic marker in acute STEMI. (Table 7)

The present study was a hospital-based prospective Observational study, which was conducted from a period of 6 months at Department of General medicine and Department of Cardiology, Silchar medical college and hospital, Silchar, Assam. The study population included 100 cases of acute STEMI and 100 age and sex matched controls.

In our study, the baseline demographic characteristics of STEMI patients and controls were comparable, with no significant differences in age or gender distribution, reflecting a balanced population for risk factor assessment. Similar observations were reported by Ulusoy et al. [2] (2010), who also noted no significant demographic differences between STEMI and control groups.  Regarding  cardiovascular  risk  factors,

hypertension, diabetes mellitus, smoking, and dyslipidemia were significantly more prevalent among STEMI patients compared to controls, highlighting their established role in the pathogenesis of acute myocardial infarction. These findings are consistent with previous studies by Chu et al. [1] (2010) and Kim et al. [7] (2016), which documented significant associations between traditional risk factors and acute coronary events.

Mean platelet volume (MPV) was significantly elevated in STEMI patients (10.2 ± 1.1 fL) compared to controls (8.5 ± 0.9 fL, p < 0.001), indicating enhanced platelet activation in the acute phase of STEMI. This aligns with the findings of Huczek et al. [3] (2005) and Boonito González et al. [5] (2016), who demonstrated that elevated MPV is associated with adverse outcomes in acute coronary syndromes. Similarly, Ulusoy et al. [2] (2010) reported higher MPV values in STEMI patients, supporting the role of platelet indices as prognostic markers.

The distribution of TIMI risk scores in our cohort showed that the majority of patients fell into the intermediate-risk category (46%), with 28% low risk and 26% high risk. MPV increased progressively across TIMI categories, with values of 9.5 ± 0.8 fL in low risk, 10.1 ± 0.9 fL in intermediate risk, and 11.0 ± 1.0 fL in high-risk patients (p < 0.001). A strong positive correlation was observed between MPV and TIMI score (r = 0.62, p < 0.001). These results are in agreement with Yılmaz et al. [8] (2021) and Zucker et al. [20] (2016), who demonstrated that higher MPV correlates with elevated TIMI risk scores, suggesting that MPV can be used as an adjunct prognostic marker in STEMI.

The relationship between MPV and Killip class in our study also revealed a progressive increase in MPV with worsening clinical severity: 9.8 ± 0.9 fL in Class I, 10.3 ± 1.0 fL in Class II, 10.8 ± 1.1 fL in Class III, and 11.2 ± 1.2 fL in Class IV (p = 0.002). These findings are consistent with those reported by Chu et al. [1] (2010) and Huczek et al. [11] (2005), emphasizing that higher MPV is associated with more severe myocardial injury and worse in-hospital outcomes. Overall, our study corroborates prior evidence that MPV is a readily available, cost-effective marker that reflects platelet activity and correlates with established prognostic scores such as TIMI and clinical severity as per Killip class. This reinforces its potential utility in risk stratification and management of STEMI patients, particularly in resource-limited settings like North-East India.

MPV also showed a strong and significant association with major adverse outcomes. Patients who developed cardiogenic shock had LVEF <50%, required ICU admission, or died during hospitalization exhibited markedly higher MPV values. These findings are consistent with those of Chandan K [12], Ayhan et al. [13] and Jindal S [14]; who demonstrated that elevated MPV predicted left ventricular dysfunction in STEMI. Likewise, Bozkurt [15] , Gürsoy et al. [16] identified MPV as an independent predictor of in-hospital mortality, while Karagöz et al. [17] linked higher MPV to the no-reflow phenomenon. Mechanistically, larger, more reactive platelets contribute to thrombosis and inflammation, as described by Gawaz et al. [18] and supported by the meta-analysis by Chu et al. [19]. Overall, MPV appears to reflect acute thrombotic and inflammatory burden rather than chronic risk exposure. Given its availability in routine blood tests, MPV may serve as a valuable, low-cost prognostic marker in STEMI, complementing established tools such as the TIMI and GRACE risk scores noted by Zucker et al. [20].

In this observational study from North-East India, mean platelet volume (MPV) was significantly elevated in patients with acute ST-elevation myocardial infarction (STEMI) compared to controls, reflecting increased platelet activation in the acute phase. MPV showed a strong positive correlation with both TIMI risk scores and Killip class, indicating that higher MPV values are associated with greater clinical severity and worse prognostic risk. These findings suggest that MPV, a simple and readily available hematological parameter, can serve as a useful prognostic marker in STEMI patients, aiding in early risk stratification and potentially guiding clinical management, especially in resource- limited settings.

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