Relation Between Leucocyte Count, Myonecrosis, Myocardial Perfusion, and Outcomes Following Primary Angioplasty

Prasad, Abhiram; Stone, Gregg W.; Stuckey, Thomas; Costantini, Costantino O.; Mehran, Roxana; Garcı́a, Eulogio; Tcheng, James E.; Cox, David A.; Grines, Cindy L.; Lansky, Alexandra J.; Gersh, Bernard J.

doi:10.1016/j.amjcard.2006.11.063

Cited by 34 publications

(26 citation statements)

References 12 publications

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“…Thus, in studies of patients experiencing acute myocardial infarction, the baseline white cell count is usually elevated. The magnitude of the white cell count is directly proportional to the likelihood for development of no-reflow phenomenon and a poor prognosis [14,15]. Many of the early experiments in animal models that documented the no-reflow phenomenon were conducted in nonatherosclerotic models.…”

Section: Local Structural Changesmentioning

confidence: 99%

Coronary no‐reflow phenomenon: From the experimental laboratory to the cardiac catheterization laboratory

Rezkalla

Kloner

2008

Cathet Cardio Intervent

190

125

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Coronary no-reflow occurs commonly during acute percutaneous coronary intervention, particularly in patients with acute myocardial infarction and those with degenerated vein grafts. It is associated with a guarded prognosis, and thus needs to be recognized and treated promptly. The pathophysiology originates during the ischemic phase and is characterized by localized and diffuse capillary swelling and arteriolar endothelial dysfunction. In addition, leukocytes become activated and are attracted to the lumen of the capillaries, exhibit diapedesis and may contribute to cellular and intracellular edema and clogging of vessels. At the moment of perfusion, the sudden rush of leukocytes and distal atheroemboli further contributes to impaired tissue perfusion. Shortening the door-to-balloon time, use of glycoprotein IIb/IIIa platelet receptor inhibitors and distal protection devices are predicted to limit the development of no-reflow during percutaneous interventions. Distal intracoronary injection of verapamil, nicardipine, adenosine, and nitroprusside may improve coronary flow in the majority of patients. Hemodynamic support of the patient may be needed in some cases until coronary flow improves.

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Section: Local Structural Changesmentioning

confidence: 99%

Coronary no‐reflow phenomenon: From the experimental laboratory to the cardiac catheterization laboratory

Rezkalla

Kloner

2008

Cathet Cardio Intervent

190

125

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“…36,37 The WBC count represents a cheap, widely available, and early indicator of the inflammatory response, and initial studies showed that an elevation in total WBC was associated with increased mortality and worse outcomes after acute MI. 38,39 Thereafter, with the recognition of a more relevant role for immune rather than inflammatory response, in the pathogenesis of CAD, attention has been addressed to leukocyte subtypes and especially the NLR, combining the effects of the nonspecific inflammatory response, mediated by neutrophils, and the subsequent regulatory immune response, involving lymphocytes. 40 Neutrophils have been claimed for every step leading to acute coronary events and can release prooxidant and prothrombotic substances, leading to endothelial damage and platelet aggregation.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil to Lymphocyte Ratio and the Extent of Coronary Artery Disease

et al. 2015

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The neutrophil to lymphocyte ratio (NLR), an inflammatory biomarker, may be of predictive and prognostic value for cardiovascular (CV) events. We evaluated the relationship of NLR with the prevalence and extent of coronary artery disease (CAD) in consecutive patients undergoing elective or urgent coronary angiography. Our population (n ¼ 3738 patients) was divided into NLR quartiles. Higher NLR was associated with aging and established CV risk factors, previous percutaneous coronary revascularization, acute presentation, and more complex pharmacological therapy. The NLR was related to platelet count, white blood cell count, creatinine, glycemia, uric acid, and C-reactive protein (all P ¼ .001) levels but inversely related to hemoglobin (P < .001), total cholesterol (P ¼ .005), and triglycerides (P < .001) levels. The NLR was associated with multivessel disease (P < .001), anterior descending, right coronary arteries (P < .001) or circumflex branch lesions (P ¼ .01), percentage of stenosis (P < .001), coronary calcification (P < .001), and intracoronary thrombus (P < .001) but inversely with in-stent restenosis (P < .001) and thrombolysis in myocardial infarction flow (P ¼ .04). The NLR was directly related to the prevalence of CAD (P ¼ .001) and severe CAD (P < .001). In patients undergoing coronary angiography, the NLR is independently associated with the prevalence and severity of CAD.

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“…1 Although this association has also been described for patients with STEMI undergoing lytic therapy, 2,3 WBCc studies in STEMI patients undergoing primary percutaneous coronary intervention (PCI) have reported conflicting findings. Some studies have found WBCc to be an independent predictor of 1-year mortality after primary PCI, 4,5 whereas others have refuted this association. 6,7 Moreover, no previous study has investigated the relation between WBCc and bleeding or infarct size in patients undergoing primary PCI.…”

mentioning

confidence: 99%

Impact of Leukocyte Count on Mortality and Bleeding in Patients With Myocardial Infarction Undergoing Primary Percutaneous Coronary Interventions

et al. 2011

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Background-The relationship between white blood cell count (WBCc) and mortality in patients with ST-segmentelevation acute myocardial infarction treated with percutaneous coronary intervention is poorly understood. Furthermore, whether there is a relationship between WBCc and risk of noncardiac mortality and bleeding after percutaneous coronary intervention is unknown. Methods and Results-The baseline WBCc was available in 3193 of 3345 patients (95.5%) who underwent percutaneous coronary intervention in the Harmonizing Outcome With Revascularization and Stent in Acute Myocardial Infarction (HORIZONS-AMI) trial. In a propensity-adjusted multivariable analysis, WBCc was an independent predictor of 1-year cardiac mortality (hazard ratio, 1.15; 95% confidence interval, 1.09 to 1.22), noncardiac mortality (hazard ratio, 1.19; 95% confidence interval, 1.10 to 1.29), and major bleeding (hazard ratio, 1.08; 95% confidence interval, 1.04 to 1.12). After adjustment for baseline creatinine phosphokinase levels and left ventricular ejection fraction, WBCc remained an independent predictor of 1-year all-cause mortality and cardiac mortality. In patients matched for baseline creatinine phosphokinase levels at hospital admission, the median peak creatinine phosphokinase level was significantly higher in patients with high WBCc (Ͼ11 000 per 1 mm 3 ) compared with low WBCc (1851 U/L [range, 880-3307 U/L] versus 1241 U/L [range, 540 to 2,78], respectively; PϽ0.0001). In this subgroup of patients, WBCc was an independent correlate of peak creatinine phosphokinase level, and remained an independent predictor of 1-year mortality. Conclusions-In patients with ST-segment-elevation acute myocardial infarction undergoing percutaneous coronary intervention, elevated baseline WBCc is an independent predictor of infarct size, as assessed by peak creatinine phosphokinase level, and of 1-year cardiac mortality, noncardiac mortality, and major bleeding. Clinical Trial Registration-URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00433966.

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Relation Between Leucocyte Count, Myonecrosis, Myocardial Perfusion, and Outcomes Following Primary Angioplasty

Cited by 34 publications

References 12 publications

Coronary no‐reflow phenomenon: From the experimental laboratory to the cardiac catheterization laboratory

Coronary no‐reflow phenomenon: From the experimental laboratory to the cardiac catheterization laboratory

Neutrophil to Lymphocyte Ratio and the Extent of Coronary Artery Disease

Impact of Leukocyte Count on Mortality and Bleeding in Patients With Myocardial Infarction Undergoing Primary Percutaneous Coronary Interventions

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