Significance of Neutrophil Counts After Reperfusion Therapy in Patients With a First Anterior Wall Acute Myocardial Infarction

Abstract

revious studies have shown that an elevated white blood cell or neutrophil count on admission is associated with a higher risk of adverse outcomes and impaired left ventricular (LV) function in acute myocardial infarction (AMI). [1][2][3][4][5][6][7][8][9][10][11][12][13] However, the significance of the neutrophil count after reperfusion therapy has not yet been investigated. In this study, we sought to clarify this significance in a first anterior wall AMI (≤6 h). Methods PatientsWe examined 122 consecutive patients (102 men, 20 women, mean age 61±11 years) with a first anterior wall AMI who were admitted within 6 h of the onset of symptoms and who met the following criteria: (1) typical chest pain lasting ≥30 min; (2) ST-segment elevation ≥0.2 mV in ≥2 adjacent precordial leads on the admission electrocardiogram; (3) an increase in the serum creatine kinase (CK) concentration more than twice the normal value; (4) no other heart or lung disease; and (5) no confounding factors such as infectious disease, collagen disease, steroid use, malignancy, and surgery within 1 month of the onset of symptoms. Informed consent for revascularization therapy and follow-up catheterization was obtained from all patients. Emergency Coronary Arteriography and Reperfusion TherapyEmergency coronary arteriography was performed using the Judkins or Amplatz technique. Multiple projections were recorded to ensure optimal visualization of the coronary vessels. The coronary flow in the infarct-related artery was graded according to the classification used in the Thrombolysis In Myocardial Infarction Trial (TIMI) trial. 14 Proximal left anterior descending coronary artery (LAD) occlusion was defined as an occlusion of the artery proximal to its first septal branch. The grade of collateral filling in the LAD was determined according to the criteria of Rentrop et al. 15 A collateral circulation with a grade of 2 or 3 was defined as "good". After angiographic confirmation of total or subtotal occlusion of the LAD, primary coronary angioplasty was performed. If an optimal result (a residual stenosis <50% without severe dissection) could not be obtained by balloon coronary angioplasty, coronary stenting was performed (n=57). Successful reperfusion was defined as the establishment of TIMI grade 3 flow in the infarct-related artery on the final coronary arteriogram. Coronary Arteriography and Left Ventriculography at PredischargeCoronary arteriography and left ventriculography were again performed at predischarge. Left ventriculograms per- Background Previous studies have demonstrated that an elevated neutrophil count on admission is associated with a higher risk of adverse events after acute myocardial infarction (AMI). However, the significance of the neutrophil count after reperfusion therapy has not been elucidated. Methods and ResultsThe association of the neutrophil count on admission and days 2 and 3 with peak creatine kinase (CK) concentration, ST-segment resolution (a marker of myocardial tissue-level reperfusion), and left ventricular...

Relationship between serum neutrophil count and infarct size in patients with acute myocardial infarction

“…As we have proven, the neutrophil count does not correlate well with biochemical markers as much as it does with scintigraphy. Our findings support previous studies [19,20].…”

“…For these reasons, the application of imaging tools such as cardiac magnetic resonance imaging or MPS must be considered when predicting infarct size. The correlative relationships are not so satisfying in the studies that deal with the neutrophilia effect on infarct size using enzymatic methods [19,20]. As we have proven, the neutrophil count does not correlate well with biochemical markers as much as it does with scintigraphy.…”

Relationship of Admission Neutrophil Count to Microvascular Injury, Left Ventricular Dilation, and Long-Term Outcome in Patients Treated With Primary Angioplasty for Acute Myocardial Infarction

“…9,21,22 The present finding of an association between high neutrophil count and LV dilation agree with previous observations. Because microvascular integrity is a major determinant of LV dilation, our results could be explained by the association between neutrophilia and microvascular injury.…”

Relationship between blood viscosity and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

“…Our study confirms and extends data of a significant association between biomarkers of cardiac damage and white blood cell count [20]. Even though neutrophil count after reperfusion therapy is augmented in response to myocardial necrosis, nonetheless increased neutrophils might lead, by themselves, to further myocardial damage, at least to some extent [20]. Moreover, the role of white blood cells as possible determinant of the no-reperfusion phenomenon and of an increased infarct size has been previously reported [21,22].…”

“…CK = creatine kinase; cTnI = cardiac troponin I. Our study confirms and extends data of a significant association between biomarkers of cardiac damage and white blood cell count [20]. Even though neutrophil count after reperfusion therapy is augmented in response to myocardial necrosis, nonetheless increased neutrophils might lead, by themselves, to further myocardial damage, at least to some extent [20].…”