We have read the recently published article entitled “Usefulness of Mean Platelet Volume (MPV) as a Biomarker for Long-Term Outcomes After Percutaneous Coronary Intervention (PCI)” by Shah and coworkers. In that very well-designed and presented study, Shah and coworkers tried to determine whether the preprocedural MPV or the change in MPV over time could be a predictor of long-term mortality in unselected patients undergoing PCI. They have shown a stronger association between an increase in the MPV over time and long-term mortality, even after multivariate adjustment. They suggested that serial assessments of MPV should be considered in evaluating prognosis.

Platelets play a pivotal role in the pathogenesis of atherosclerosis. They were also associated with adverse clinical outcomes, whereas a greater subsequent platelet count decrease was associated with an increased risk of reinfarction. MPV, a measure of platelet size available in every blood count, is increasingly recognized as an important marker of platelet activity. MPV has been well demonstrated to influence prognosis and angiographic results in patients with acute myocardial infarction and after PCI. Microvascular obstruction by white cells and platelets plugging, so far as vasoconstriction because of platelet release of thromboxanes and other mediators, have been claimed as possible mechanisms. Platelet function can be affected by obesity. Platelet parameters might be influenced by coronary risk factors including age, obesity, smoking, diabetes mellitus, hypertension, hyperlipidemia, metabolic syndrome, and deep vein thrombosis. Some other recent studies have demonstrated that an elevated MPV is linked with peripheral artery disease, stroke, and atrial fibrillation, all related to atherosclerosis on the basis of inflammation. The MPV can also be affected by thyroid and rheumatic diseases, malignancy, and medications such as anticoagulant therapy and statins.

Additionally, obstructive sleep apnea syndrome may be associated with increased cardiovascular morbidity and mortality on the basis of coronary atherothrombosis. Also, platelet activation is increased in patients with obstructive sleep apnea syndrome. Platelet activation and aggregation are central processes in the pathophysiology of atherothrombosis. MPV, which represents platelet activation, is a newly emerging risk factor for atherothrombosis. Nonalcoholic fatty liver disease (NAFLD), the most common liver disease, is common in overweight or obese patients and may have an association with cardiovascular risk factors and atherosclerosis. NAFLD incidence is significantly greater with increased MPV, and after controlling for factors associated with NAFLD, there was a significant correlation between MPV and NAFLD.

In conclusion, the MPV may be affected by many factors. So, not only MPV but also red cell distribution width, platelet distribution width, neutrophil lymphocyte ratio, C-reactive protein, and uric acid are easy methods to evaluate the risk of periprocedural events in both elective patients and those with acute coronary syndrome undergoing PCI. MPV might be evaluated together with other inflammatory markers such as neutrophil lymphocyte ratio and red cell distribution width.