I read with great interest the recent report by Goncalves et al on the usefulness of mean platelet volume (MPV) as a prognostic biomarker after percutaneous coronary intervention (PCI). In this study, the investigators assessed the prognostic importance of MPV as a biomarker for long-term outcomes after PCI and demonstrated that the presence of higher MPV values and diabetes mellitus is a strong independent predictor of long-term outcomes after PCI. This is in association with the findings of Yang et al, who found that MPV was a marker of restenosis after PCI. Along with these findings, in a recent study, Yılmaz et al evaluated the role of MPV in patients with acute coronary syndromes and demonstrated that MPV is significantly higher in patients with acute coronary syndromes than in those with stable coronary heart disease, and furthermore, it was shown that MPV values were significantly higher in patients requiring urgent PCI. In fact, platelets are quite heterogenous blood elements, diverging in terms of size, density, and reactivity. Platelet size has been shown to reflect platelet activity, and along with this finding there is evidence that MPV is an important biologic variable and that immature platelets have larger MPV values with higher thrombotic potential. On the basis of these findings, increased MPV may reflect more aggressive platelet behavior and that larger and hyperactive platelets might be accelerating the formation and propagation of intracoronary thrombus, leading to the occurrence of clinical events.

In conclusion, MPV is a simple and easy measure of platelet function, and using MPV as a prognostic biomarker after PCI for the prediction of long-term outcomes seems logical. Along with this, MPV might have a role as a therapy-directing marker in patients with acute coronary syndromes and in directing antiplatelet therapy in patients who undergo PCI.