Association of peripheral neutrophilia with adverse angiographic outcomes in ST-elevation myocardial infarction
Association of peripheral neutrophilia with adverse angiographic outcomes in ST-elevation myocardial infarction
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DOI：
10.1016/j.amjcard.2003.11.013
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发表时间：
2004-03-01
影响因子：
2.8
通讯作者：
Gibson, CM
中科院分区：
文献类型：
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作者：
Kirtane, AJ;Bui, A;Gibson, CM
我们假设，在 394 名患者进行的急性心肌梗死溶栓后限制性心肌梗死 (LIMIT) 急性心肌梗死 (AMI) 试验中，对 ST 抬高型心肌梗死进行纤维蛋白溶解试验，绝对和相对中性粒细胞增多与不良血管造影结果相关。平均中性粒细胞计数为 7.9 x 10(9)/L，平均中性粒细胞百分比为 72%。从症状出现到纤溶治疗时间超过中位时间（2.7 小时）的患者比治疗时间较短的患者具有更高的中性粒细胞计数和中性粒细胞百分比。 90 分钟时梗塞相关动脉闭合的患者（心肌梗塞溶栓 [TIMI] 0/1 级血流）的中性粒细胞计数较高（8.8 +/- 3.8 vs 7.6 +/- 3.0，p = 0.02），但中性粒细胞百分比与动脉开放的患者相比没有差异。较高的中性粒细胞计数也与梗塞相关动脉中较长的校正 TIMI、帧计数 (CTFC) 轻度相关 (r = 0.14，p = 0.02)。根据 TIMI 心肌灌注分级 (TMPG) 判断心肌灌注受损的患者中性粒细胞百分比较高（TMPG 0/1 为 73.2 +/- 10.7%，TMPG -2/3 为 69.9 +/- 12.6%，p = 0.047），但中性粒细胞计数没有可检测到的差异（8.2 +/- 3.3 与 7.7 +/- 2.9，P = 0.24）。细胞分化的其他指标与血管造影或临床结果之间没有显着相关性。在控制了年龄、左前降支梗塞位置、治疗时间以及入院时脉搏和血压的多变量模型中，较高的中性粒细胞计数仍然与动脉闭合和 CTFC 独立相关。在类似的多变量模型中，更大比例的中性粒细胞仍然与微血管灌注受损独立相关。在 ST 段抬高型心肌梗死患者中，绝对和相对中性粒细胞增多与心外膜和微血管灌注受损有关。 (C) 2004 年，Excerpta Medica, Inc.
We hypothesized that absolute and relative neutrophilia would be associated with adverse angiographic outcomes in the 394 patient Limitation of Myocardial Infarction Following Thrombolysis in Acute Myocardial Infarction (LIMIT) Acute Myocardial Infarcion (AMI) trial of fibrinolysis in ST-elevation myocardial infarction. The mean neutrophil count was 7.9 x 10(9)/L, with a mean neutrophil percentage of 72%. Patients with time from symptom onset to fibrinolytic treatment more than the median (2.7 hours) had a higher neutrophil count and percentage of neutrophils than patients with shorter time to treatment. Patients with a closed infarct-related artery at 90 minutes (Thrombolysis In Myocardial Infarction [TIMI] grade 0/1 flow) had higher neutrophil counts (8.8 +/- 3.8. vs, 7.6 +/- 3.0, p = 0.02) but no difference in the percentage of neutrophils than patients with an open artery. Higher neutrophil counts were also mildly correlated with longer corrected TIMI, frame counts (CTFC) in the infarct-related artery (r = 0.14, p = 0.02). Patients with impaired myocardial perfusion by TIMI myocardial perfusion grade (TMPG) had a greater percentage of neutrophils (73.2 +/- 10.7% for TMPG 0/1 vs 69.9 +/- 12.6% for TMPG -2/3, p = 0.047) but no detectable difference in neutrophil counts (8.2 +/- 3.3 vs 7.7 +/- 2.9, P = 0.24). There were no significant associations between other indexes in the cell differential and angiographic or clinical outcomes. Higher neutrophil counts remained independently associated with both closed arterues and CTFC in multivariable models controlling for, age, left anterior descending artery infarct location, time to treatment, and pulse and blood pressure on admission. A greater percentage of neutrophils remained independently associated with impaired microvascular perfusion in a similar multivariable model. In patients with ST-elevation myocardial infarction, absolute and relative neutrophilia were associated with impaired epicardial and microvascular perfusion. (C) 2004 by Excerpta Medica, Inc.