Coronary artery disease
Association of Leukocyte and Neutrophil Counts With Infarct Size, Left Ventricular Function and Outcomes After Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2008.09.085Get rights and content

Elevated leukocyte count during ST-segment elevation myocardial infarction is associated with adverse clinical outcomes. Whether increased leukocyte count after primary percutaneous coronary intervention (PCI) directly reflects larger infarct size and left ventricular impairment is not known. The aim of this study was to assess the relation between leukocyte and neutrophil counts with infarct size and the left ventricular ejection fraction (LVEF) after primary PCI. Three hundred sixty-three patients from the Evaluation of MCC-135 for Left Ventricular Salvage in Acute Myocardial Infarction (EVOLVE) study, a randomized, double-blind, placebo-controlled trial assessing the efficacy of intracellular calcium modulator as an adjunct to primary PCI in patients with first ST-segment elevation myocardial infarctions, were evaluated. Total and differential leukocyte counts were measured before and serially after PCI. Infarct size and the LVEF were assessed using single-photon emission computed tomography after 5 and 30 days, and patients were followed up to 180 days. Total leukocyte and neutrophil counts obtained 24 hours after PCI were significantly correlated with infarct size (r = 0.34 and 0.37, respectively, p <0.001) and inversely correlated with the LVEF (r = −0.20 and −0.22, respectively, p <0.001). Patients with elevated leukocyte and neutrophil counts had larger infarct sizes (12.5% vs 5% and 13.5% vs 5%, respectively, p <0.001). The highest neutrophil quartile was associated with increased 180-day composite cardiac events (19% vs 20% vs 23% vs 45%, log-rank p <0.001). Elevated leukocyte and neutrophil counts independently predicted adverse cardiac events (hazard ratios 2.5 and 2.2, respectively, p = 0.001). In conclusion, elevated leukocyte and neutrophil counts after primary PCI in patients with ST-segment elevation myocardial infarctions are directly related to myocardial infarct size and the LVEF and are independent predictors of cardiovascular outcomes.

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Methods

Details of the Evaluation of MCC-135 for Left Ventricular Salvage in Acute Myocardial Infarction (EVOLVE) trial have been published previously.4, 5 In brief, EVOLVE was a phase IIA, multicenter, randomized, double-blind, placebo-controlled study of the safety and efficacy of 2 doses of intravenous MCC-135, a new class of agent that reduces intracellular calcium overload, as an adjunct therapy for the preservation of LV function and reduction of infarct size in patients who undergo PCI for

Results

In this analysis, we included 363 patients (73% of the patients enrolled in the EVOLVE study) who had white cell counts assessed within 24 hours of admission, underwent primary PCI, and underwent follow-up SPECT imaging. Clinical characteristics of the study cohort and procedural findings are listed in Table 1. The profiles of total leukocyte, neutrophil, and lymphocyte counts from time of admission to 30 days thereafter are shown in Figure 1. Total leukocyte and neutrophil counts were modestly

Discussion

The major findings of the present study are that (1) elevated leukocyte and neutrophil counts after primary PCI are related to adverse clinical outcomes in patients with STEMIs, (2) there is direct correlation between leukocyte counts and myocardial infarct size and LV function determined by SPECT imaging, and (3) high leukocyte and neutrophil counts postprocedurally are independent predictors of cardiovascular outcomes.

The association between thrombotic and inflammatory pathways in acute

Acknowledgment

We would like to thank the EVOLVE Scientific Advisory Committee and Data Safety and Monitoring Committee and all the participating investigators and institutions in the EVOLVE study.

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Dr. Chia is the recipient of the National Medical Research Council Medical Research Fellowship and Health Manpower Development Program Fellowship, Singapore. The Evaluation of MCC-135 for Left Ventricular Salvage in Acute Myocardial Infarction (EVOLVE) study was supported by a grant from Mitsubishi Pharma Corporation, Osaka, Japan.

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