الفهرس 
MEGAKARYOPOIESISOnly 14 pages are availabe for public view
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Abstract
SUMMARY
urrent evidence indicates that ischaemic heart disease is the commonest cause of death in most developing countries. Present cardiac markers are not sufficiently sensitive at an early stage of ACS. As such, an early, rapidly available and independent marker is needed for accurate diagnosis of ACS in the emergency department. This could lead to lower hospitalisation rates and also avoid discharging patients who have an ACS. Thrombosis is a major cause of ACS. Platelets play an important role in developing intravascular thrombus. It was well proved that platelets play a central role in both initiation and propagation of ACS. Platelet size has been shown to reflect platelet activity. Large platelets are metabolically and enzymatically more active than small platelets. Platelet activation is measured via MPV. The purpose of this study is to explore the ability of MPV to detect ACS in patients with acute chest pain and determining its ability to differentiate ACS from non-ACS patients.
The study was conducted on 202 patients with acute chest pain of 8 hours duration. ACS was diagnosed in 145 (71.8%), of whom 76 (52.4%) were AMI and 69 (47.6%) were UA patients. Patients with acute chest pain due to non-ACS were 57(28.2%). All patients were subjected to history taking to confirm that all included patients satisfied the inclusion and exclusion criteria. On admission all patients had a blood sample taken for evaluation of total leucocytic count, MPV, platelet count, TnI, LDH, total CK and CK-MB. Further follow up of the patients till final diagnosis was done to classify the patients into the different groups. Regarding the epidemiological factors, diabetes mellitus and presence of previous IHD were statistically higher in the ACS than the non-ACS patients. Other factors as age, gender, hypertension, smoking, family history and dyslipidemia were similarly distributed between the two groups with no statistically significant difference. As for complications, the AMI patients were more liable for complications than UA patients.
On comparing the ACS with the non-ACS patients, all laboratory parameters were significantly higher compared to
the non-ACS group except regarding the platelet count and Total CK. The MPV was significantly higher in the ACS compared to non-ACS patients. Also within the ACS group, the AMI and UA patients both showed a significantly higher MPV compared to non-ACS patients. In the AMI and UA patients, the MPV had a negative correlation with platelet count. On the other hand MPV was not affected by any other epidemiological or clinical variable. In differentiating ACS from non-ACS, a cut off value of 9.05 fL was determined with 68% sensitivity and 88% specificity. The same cut off value with similar sensitivity and specificity was determined for AMI and UA. For patients with AMI, TnI had a cut off value of 0.035 ng/mL with sensitivity of 79% and specificity of 92%. Combining the MPV and TnI increased sensitivity to 82% and specificity to 96%.
Patients with AMI presenting in the first 4 hrs of chest pain had a cut off value for MPV of 9.05 fL (sensitivity 71% and specificity 88%) and for TnI at 0.035 ng/mL (sensitivity 66% and specificity 92%). Combining the two markers increased sensitivity to 74% and specificity to 96%.