Relation Between Neutrophil Counts on Admission, Microvascular Injury, and Left Ventricular Functional Recovery in Patients With an Anterior Wall First Acute Myocardial Infarction Treated With Primary Coronary Angioplasty

Takahashi, Takefumi; Hiasa, Yoshikazu; Ohara, Yoshikazu; Miyazaki, Shôzo; Ogura, Riyo; Miyajima, Hitoshi; Yuba, Kenichiro; Suzuki, Naoki; Hosokawa, Shinobu; Kishi, Koichi; Ohtani, Ryuji

doi:10.1016/j.amjcard.2007.02.049

Cited by 50 publications

(34 citation statements)

References 27 publications

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“…In the present study, the neutrophil count, a strong independent predictor of no-reflow, which has been described in previous research, is of particular interest [15]. The possible mechanism which may explain that the neutrophil count is associated with no-reflow is reperfusion injury.…”

Section: Discussionmentioning

confidence: 81%

Development and Validation of a Clinical Risk Score Predicting the No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Wang

Chen

Wang³

et al. 2013

Cardiology

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Objective: The ‘no-reflow' phenomenon after a primary percutaneous coronary intervention (pPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) is a strong predictor of both short- and long-term mortality. We therefore developed and prospectively validated a risk score system in order to identify STEMI patients at high risk in terms of no-reflow after primary PCI. Methods: The first part of our study used data from 1,615 STEMI patients who underwent primary PCI within 12 h from symptom onset. Using logistic regression, we derived a risk score to predict angiographic no-reflow using baseline clinical variables. From this score, we developed a simplified fast-track screen that can be used before reperfusion. In the second part of our study, we prospectively validated the score system using receiver-operating characteristic (ROC) curves with data from 692 STEMI patients. Results: The model included six clinical items: age, neutrophil count, admission plasma glucose, β-blocker treatment, time-to-hospital admission and Killip classes. The risk score system demonstrated a good risk prediction with a c-statistic of 0.757 (95% CI 0.732-0.781) based on ROC analysis. Conclusion: A simple risk score system based on clinical variables is useful to predict the risk of developing no-reflow after pPCI in patients with STEMI.

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Section: Discussionmentioning

confidence: 81%

Development and Validation of a Clinical Risk Score Predicting the No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Wang

Chen

Wang³

et al. 2013

Cardiology

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“…Since leukocyte increase was shown to be related to microvascular injury [21] and infarct size [22], it is suggested that the increase of white blood cell could serve as a contributing factor to early SO by way of inflammatory reactions producing impaired microvascular perfusion and more necrotic change, leading to left ventricular dysfunction. C-reactive protein on admission, in contrast, was not selected as a predictor here; its elevation follows the leukocyte recruitment and thus, may not be useful as an early-stage surrogate biomarker.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Predictors of Stent Restenosis and Early Stent Occlusion in Patients with Acute Myocardial Infarction Treated by Bare Metal Stents: Importance of Infarct Location and Serum Creatinine Level

Uemori¹,

Sugitani²,

Tamada³

et al. 2014

Angiol

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GroupsAmong these 242 patients, 226 underwent either ischemia-driven or planned follow-up coronary angiography within 8 months. Thus, *Corresponding author: Manabu Shirotani, Cardiology Department, Nara Hospital, Kinki University Faculty of Medicine, 1248-1, Otoda-Cho, Ikoma, Nara, 630-0293, Japan, Tel: +81 743 77 0880; Fax: +81 743 77 0901; E-mail: manabu@nara.med.kindai.ac.jp AbstractBackground: Bare Metal Stents (BMS) have been commonly used for recanalization of an infarct-related artery in Japanese patients with Acute Myocardial Infarction (AMI). We sought to examine predictors of binary restenosis and early Stent Occlusion (SO) in these patients. Methods:Among 242 consecutive patients with AMI treated by BMS implantation as reperfusion therapy, 226 underwent either ischemia-driven or follow-up coronary angiography within 8 months. Restenosis change in the stented segment was found in 56. Among them, 10 patients had early SO on an angiogram. Multivariate analysis was performed to obtain predictors of restenosis and early SO.Results: Predictors for restenosis were Left Anterior Descending Artery (LAD) involvement (odds ratio (OR) 2.32, p=0.024), serum creatinine (SCr) on admission (OR 1.29 per 0.1mg/dl increase, p=0.001), and stent size (OR 0.43 per 0.5mm increase, p=0.001). Those for early SO were left main trunk or LAD involvement (OR 27.0, p=0.029), SCr (OR 1.65 per 0.1mg/dl increase, p=0.005) and leukocyte count (OR 1.28 per 1,000/microliter increase, p=0.037) on admission. SCr was significantly higher in patients with early SO than in those with restenosis (median 1.05, Interquartile Range (IQR) 0.80-1.10 vs. median 0.80, IQR 0.70-1.00, p=0.035). Conclusion:In patients with AMI treated with BMS, both restenosis and early SO were increased by anterior wall involvement and elevation of SCr level. Higher SCr may be subject to more occlusive changes. It is suggested that in early SO, an inflammatory mechanism may be involved.

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“…With regard to predictors of reperfusion-related injury, a promptly available clinical predictor of MVO is neutrophil count, which has been recently associated with microvascular injury after primary PCI [158]. Platelets also play an important role in MVO.…”

Section: Predictors Of the Different Pathogenetic Components Of Mvomentioning

confidence: 99%

CMD in Obstructive CAD

Crea

Lanza

Camici

2013

Coronary Microvascular Dysfunction

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In 1974, Gould et al. described the effects of progressive coronary artery narrowing on resting and maximal coronary blood flow in a canine model [1]. A reduction in coronary artery diameter of C50 % limited maximal coronary vasodilator capacity and a reduction of C85 % limited resting coronary blood flow. These laboratory findings were soon transposed into the clinical setting, where a stenosis C50 % of luminal diameter was defined as a hemodynamically significant lesion and one C85 % as a critical lesion [2]. The notion of ''critical coronary stenosis'' was then further translated into ''ischemia-causing stenosis.'' Based on this chain of postulates, coronary stenosis gained increasing recognition as a consistent cause of angina.The results of the experimental findings of Gould et al. have been recently confirmed in patients using PET and quantitative coronary angigography [3,4]. Of note, these studies have clearly shown that, in patients with stable CAD, there is no reduction in MBF in resting conditions even with coronary stenosis [90 %, likely due to the presence of an effective collateral circulation.Therefore, when a relatively simple percutaneous technique, such as angioplasty, that could reduce the atherosclerotic obstruction was introduced [5], the cardiology community reacted with enormous enthusiasm and promptly endorsed the methodology.However, following millions of procedures performed worldwide, outcome analysis does not support the initial enthusiasm, at least in a large subset of patients with stable CAD. Several lines of evidence suggest that the direct relationship between chronic obstructive coronary atherosclerosis and angina has been taken for granted and may represent an overly simplified view. Indeed, many patients with angina and evidence of myocardial ischemia do not have detectable coronary atherosclerosis at angiography, as highlighted in the section on MVA (Chap. 4);

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Relation Between Neutrophil Counts on Admission, Microvascular Injury, and Left Ventricular Functional Recovery in Patients With an Anterior Wall First Acute Myocardial Infarction Treated With Primary Coronary Angioplasty

Cited by 50 publications

References 27 publications

Development and Validation of a Clinical Risk Score Predicting the No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Development and Validation of a Clinical Risk Score Predicting the No-Reflow Phenomenon in Patients Treated with Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Incidence and Clinical Predictors of Stent Restenosis and Early Stent Occlusion in Patients with Acute Myocardial Infarction Treated by Bare Metal Stents: Importance of Infarct Location and Serum Creatinine Level

CMD in Obstructive CAD

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