Beyond Platelet Indices, WBC-to-MPV Ratio in Myocardial Infarction With Non-Obstructive Coronary Arteries (MINOCA) Correlate With Short-Term Rather Than In-Hospital Outcomes

Globally, ischemic heart disease remains a significant cause of death, and its prevalence constantly increases. Around 5-15% of acute myocardial infarction (AMI) patients show nonobstructive (<50% stenosis) coronary arteries, named myocardial infarction with nonobstructive coronary arteries (MINOCA).

There are two main phases of inflammation during myocardial infarction: the inflammatory phase and the proliferative phase. The white blood cell (WBC) count and its subtypes have been investigated as potential predictors of cardiovascular outcomes in patients with coronary artery disease (CAD), serving as inflammatory markers.

The mean platelet volume (MPV) is determined in the progenitor cell, the bone marrow megakaryocyte. The platelet volume is found to be associated with cytokines (thrombopoietin, interleukin-6, and interleukin-3) that regulate megakaryocyte ploidy and platelet number and result in the production of larger platelets.

Inclusion criteria

• Age ≥18 years old.
• Both sexes.
• Patients with acute myocardial infarction (AMI). Myocardial infarction with nonobstructive coronary arteries (MINOCA) is diagnosed if a patient fulfilled the AMI criteria in the absence of obstructive coronary arteries (type I: <50% stenosis; or type II: no stenosis) as recommended by the recent American Heart Association statement that introduces an updated definition incorporating the 4th universal MI definition, which by agreement excludes Takotsubo syndrome and myocarditis from the eventual diagnosis of MINOCA.

Exclusion criteria

• Previous history of MI or coronary revascularization (PCI or bypass surgery) with acute/chronic infection.
• Autoimmune diseases.
• Systemic inflammatory disease.
• Patients on treatment therapy which critically affects inflammatory cell count.
• Patients with malignancy.
• Chronic kidney disease.
• Severe liver disease.
• Severe anemia.
• Fever (>38°C).