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
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
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DOI：
10.1016/j.amjcard.2007.02.049
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发表时间：
2007-07-01
影响因子：
2.8
通讯作者：
Ohtani, Ryuji
中科院分区：
文献类型：
--
作者：
Takahashi, Takefumi;Hiasa, Yoshikazu;Ohtani, Ryuji
中性粒细胞计数增加与急性心肌梗死（AMI）后不良临床事件风险增加相关。我们研究了AMI患者入院时中性粒细胞计数与直接冠状动脉成形术后微血管损伤程度和左室功能恢复之间的关系。我们研究了116例首次前壁AMI患者，他们在发病12小时内接受了直接冠状动脉成形术。根据初始中性粒细胞计数将患者分为3组：低（<5，000/ mm（3）），中等（5，000至10，000/mm（3））和高（> 10，000/mm（3））。再灌注后立即使用多普勒导丝评估冠状动脉血流速度参数。我们将严重微血管损伤定义为收缩期血流逆转和舒张期减速时间< 600 Ins。在血运重建前和血运重建后4周分析超声心动图室壁运动。在中性粒细胞计数高的患者中，收缩期血流逆转更常见，舒张期减速时间更短，冠状动脉血流储备更低。通过回归分析，中性粒细胞计数与舒张期减速时间（r =-0.38，p < 0.0001）、冠状动脉血流储备（r =-0.33，p = 0.0004）和室壁运动变化评分（r =-0.36，p = 0.0004）显著相关。多变量分析显示，入院时中性粒细胞计数是严重微血管损伤的独立预测因子（比值比2.94，p = 0.02）。总之，入院时的嗜中性粒细胞与直接冠状动脉成形术后微血管再灌注受损和功能恢复不良有关。(C)2007年爱思唯尔公司All rights reserved.
Increased neutrophil counts have been associated with an increased risk of adverse clinical events after acute myocardial infarction (AMI). We examined the association of neutrophil counts on admission with degree of microvascular injury and left ventricular functional recovery after primary coronary angioplasty in AMI. We studied 116 patients with a first anterior wall AMI who underwent primary coronary angioplasty within 12 hours of onset. Patients were categorized into 3 groups based on initial neutrophil count: low (< 5,000/ mm(3)), intermediate (5,000 to 10,000/mm(3)), and high (> 10,000/mm(3)). Coronary flow velocity parameters were assessed immediately after reperfusion using a Doppler guidewire. We defined severe microvascular injury as the presence of systolic flow reversal and a diastolic deceleration time < 600 Ins. Echocardiographic wall motion was analyzed before revascularization and 4 weeks after revascularization. In patients with a high neutrophil count, systolic flow reversal was more frequently observed, diastolic deceleration time was shorter, and coronary How reserve was lower. By regression analysis, neutrophil count significantly correlated with diastolic deceleration time (r = -0.38, p < 0.0001), coronary flow reserve (r = -0.33, p = 0.0004), and score for change in wall motion (r = -0.36, p = 0.0004). Multivariate analysis showed that neutrophil count on admission was an independent predictor of severe microvascular injury (odds ratio 2.94, p = 0.02). In conclusion, neutrophilia on admission is associated with impaired microvascular reperfusion and poor functional recovery after primary coronary angioplasty. (C) 2007 Elsevier Inc. All rights reserved.