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.