Clinical Utility of Immature Platelet Fraction (IPF) as a Biomarker in the Diagnosis of Acute Coronary Syndrome (ACS)

Introduction Acute coronary syndrome (ACS) is a critical medical emergency requiring prompt diagnosis and treatment to prevent severe complications, including death, and the underlying pathology of ACS involves the rupture or erosion of an atheromatous plaque within the coronary arteries. Platelets get consumed in an atherosclerotic blood vessel (artery) soon after the rupture of atherosclerotic plaque, which can result in the release of larger immature platelets from bone marrow. The primary objective of this study was to determine the clinical utility of immature platelet fraction (IPF) as a biomarker in the diagnosis of ACS. As secondary objectives, we tried to determine the association between mean platelet volume (MPV) and IPF in the diagnosis of ACS and to determine the role of IPF in differentiating single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD). Materials and methods A pilot study was conducted with 15 samples, and the sensitivity of IPF (90%) to diagnose ACS was obtained with a 95% confidence interval and 10% allowable error; the overall minimum sample size came to 53 (including a minimum 35 ACS). Fifty-four patients with chest pain, including patients who presented to the emergency room (ER) and who got admitted in the ward and critical care unit (CCU), satisfying the inclusion criteria, were included in the study. Statistical analysis was done using the IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, NY). The results are given in mean ± SD for all the continuous variables and in frequency (percentage) for categorical variables. The normality of the data was checked by the Kolmogorov-Smirnov Z test. The receiver operating characteristic (ROC) curve was applied to find an ideal cut-off of IPF for the diagnosis of ACS with respect to ECG and cardiac enzymes. Diagnostic measures such as sensitivity and specificity were applied. To test the statistical significance of the difference in the proportion of IPF and MPV with ACS, the Chi-square test was used, and the same test was used to differentiate SVD, DVD, and TVD using IPF with respect to coronary angiogram (CAG). Pearson's correlation coefficient was applied to find the correlation of IPF with MPV and platelet count, and its statistical significance was checked by linear reg t test. Results Among the 54 participants, 38 (70.4%) were diagnosed with ACS, while 16 (29.6%) were found to have non-cardiac chest pain. The ROC curve was plotted, and a cut-off value of 1.7250% was determined for IPF with a sensitivity of 94.7% and a specificity of 93.7%. The area under the ROC curve (AUC) was 0.984, with a standard error of 0.014 (p < 0.001). There was a strong positive correlation between IPF and MPV (r = 0.731, p < 0.001) in ACS patients. Conclusion Our study demonstrates that IPF and MPV are valuable biomarkers for the diagnosis of ACS.