Prognostic value of culprit site neutrophils in acute coronary syndrome

被引：44

作者：

Distelmaier, Klaus ^{[1
,2
]}

Winter, Max-Paul ^{[1
]}

Dragschitz, Florian ^{[1
]}

Redwan, Bassam ^{[1
,3
]}

Mangold, Andreas ^{[1
]}

Gleiss, Andreas ^{[4
]}

Perkmann, Thomas ^{[5
]}

Maurer, Gerald ^{[1
]}

Adlbrecht, Christopher ^{[1
]}

Lang, Irene M. ^{[1
]}

机构：

[1] Med Univ Vienna, Div Cardiol, Dept Internal Med 2, A-1090 Vienna, Austria

[2] Mayo Clin, Coll Med, Div Endocrinol, Rochester, MN USA

[3] Univ Munster, Dept Cardiothorac Surg, D-48149 Munster, Germany

[4] Med Univ Vienna, Sect Clin Biometr, Ctr Med Stat Informat & Intelligent Syst, A-1090 Vienna, Austria

[5] Med Univ Vienna, Dept Med & Chem Lab Diagnost, A-1090 Vienna, Austria

来源：

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION | 2014年 / 44卷 / 03期

关键词：

Acute coronary syndrome; neutrophils; prognosis; ELEVATION MYOCARDIAL-INFARCTION; TIMI RISK SCORE; ANGIOGRAPHIC OUTCOMES; ASSOCIATION; DISEASE; COUNT; MORTALITY; DNA;

D O I：

10.1111/eci.12228

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundRecent data suggest that acute coronary syndromes (ACS) and acute myocardial infarction (AMI) are characterized by an inflammatory subset of thrombosis. We have previously described the accumulation of neutrophils at the coronary culprit lesion site. In this work, we assessed the prognostic value of culprit site (CS) neutrophil accumulation on long-term mortality in patients with AMI. Materials and methodsIn this prospective study, 417 AMI patients were enrolled after thrombectomy during primary percutaneous coronary intervention. The optimal cut-off for CS neutrophil accumulation for predicting 4-year all-cause mortality was calculated using time-dependent receiver operator characteristic curve analyses. ResultsThe median follow-up time was 39months interquartile range (IQR 21<bold>4</bold>-54<bold>6</bold>months) corresponding to 1217 patient years of follow-up. The cut-off for CS neutrophil accumulation (difference between culprit neutrophil counts and systemic neutrophil counts) was 0<bold>25</bold> Giga/l. CS neutrophil accumulation occurred in 195 patients (47%) and was independently associated with mortality (hazard ratio 1<bold>88</bold> (95%CI 1<bold>02</bold>-3<bold>41</bold>, P=0<bold>043</bold>)). In patients with CS neutrophil accumulation, 1-year mortality (10<bold>8</bold>% vs. 7<bold>2</bold>%) and 4-year mortality (19<bold>8</bold>% vs. 10<bold>4</bold>%) were markedly increased compared with patients without local neutrophil accumulation. Concordance index for CS neutrophil accumulation and mortality was 0<bold>64</bold> (95% CI 0<bold>51</bold>-0<bold>77</bold>; P=0<bold>035</bold>). Patients with CS neutrophil accumulation had significantly more often nonobstructive lesions compared with patients without neutrophil accumulation (32<bold>6</bold>% vs. 22<bold>4</bold>%; P=0<bold>024</bold>). Conclusions Neutrophil accumulation at the coronary culprit lesion site is a strong and independent predictor of mortality in patients with ACS/AMI.

引用

页码：257 / 265

页数：9

共 35 条

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