Prognostic value of a decrease in mean platelet volume, platelet distribution width, and platelet-large cell ratio for major adverse cardiovascular events after myocardial infarction without ST-segment elevation: An observational study

The current study aimed to explore whether the level of decrease in platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and mean platelet volume (MPV) has prognostic value for major adverse cardiovascular events (MACEs) in acute myocardial infarction without ST-segment elevation (NSTEMI) treated with clopidogrel. In this prospective observational cohort study, PDW, P-LCR, and MPV were determined on admission at the hospital and 24 h after clopidogrel treatment in 170 non-STEMI patients. MACEs were assessed over a one-year follow-up period. Using the Cox regression test, a decrease in PDW showed a significant association with the incidence of MACEs (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.66–0.99, p ═ 0.049) and overall survival rate (OR 0.95, 95% CI ═ 0.91–0.99, p ═ 0.016). Patients with a decrease in PDW<9.9% had a higher incidence of MACEs (OR 0.42, 95% CI ═ 0.24–0.72, p ═ 0.002) and a lower survival rate (OR 0.32, 95% CI ═ 0.12–0.90, p ═ 0.03) than patients who had a decrease in PDW<9.9%. In the Kaplan–Meier analysis using log-rank test, patients who had a decrease in PDW<9.9% had an increased risk for MACEs (p ═ 0.002) and lethal outcomes (p ═ 0.002). However, a decrease in MPV or P-LCR did not have prognostic value. A decrease in PDW<9.9% measured 24 h after clopidogrel treatment in NSTEMI patients has good prognostic value for determining the short-term risks of MACEs, possibly providing a better risk stratification of those patients.