Key result
Higher neutrophil count in STEMI is linked to ~4-fold more persistent ST-segment elevation despite thrombectomy.
Why the study?
An elevated neutrophil count in STEMI is associated with microvascular dysfunction and adverse outcomes, but the effect of aspiration thrombectomy on this dysfunction is unclear.
Does aspiration thrombectomy improve microvascular dysfunction in STEMI patients with an elevated neutrophil count?
Cohort (n=70)
No
Does aspiration thrombectomy improve microvascular dysfunction in STEMI patients with an elevated neutrophil count?
A higher neutrophil count at presentation in STEMI is associated with more severe microvascular dysfunction after primary PCI, which is not improved with aspiration thrombectomy.
Answers are grounded in this paper and cite their sources.
Higher neutrophil count signals worse microvascular recovery after thrombectomy in STEMI; hypothesis-generating for neutrophil-targeted strategies.
Background and Objectives Aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI) is an effective adjunctive therapy for ST-segment elevation myocardial infarction (STEMI). An elevated neutrophil count in STEMI is associated with microvascular dysfunction and adverse outcomes. We evaluated whether AT can improve microvascular dysfunction in patients with STEMI and an elevated neutrophil count. Subjects and Methods Seventy patients with STEMI undergoing primary PCI from August 2007 to February 2009 in our institution were classified by tertiles of neutrophil count on admission (<5,300/mm3, 5,300-7,600/mm3, and >7,600/mm3). The angiographic outcome was post-procedural thrombolysis in myocardial infarction (TIMI) flow grade. Microvascular dysfunction was assessed by TIMI myocardial perfusion (TMP) grade and ST-segment resolution on electrocardiography 90 minutes after PCI. The clinical outcome was major adverse cardiac event (MACE), defined as cardiac death, re-infarction, and target lesion revascularization at 9 months. Results There were no significant differences in the clinical characteristics and pre- and post-procedural TIMI flow grades between the neutrophil tertiles. As the neutrophil count increased, a lower tendency toward TMP grade 3 (83% vs. 52% vs. 54%, p=0.06) and more persistent residual ST-segment elevation (>4 mm: 13% vs. 26% vs. 58%, p=0.005) was observed. The 9-month MACE rate was similar between the groups. On subgroup analysis of AT patients (n=52) classified by neutrophil tertiles, the same tendency toward less frequent TMP grade 3 (77% vs. 56% vs. 47%, p=0.06) and persistent residual ST-segment elevation (>4 mm: 12% vs. 28% vs. 53%, p=0.05) was observed as neutrophil count increased. Conclusion A higher neutrophil count at presentation in STEMI is associated with more severe microvascular dysfunction after primary PCI, which is not improved with AT.
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Lee et al. (2011) conducted a cohort in ST-Segment Elevation Myocardial Infarction (STEMI) (n=70). Elevated neutrophil count vs. Lower neutrophil count was evaluated on Persistent residual ST-segment elevation (>4 mm) 90 minutes after PCI (p=0.005). Higher admission neutrophil count in STEMI patients undergoing primary PCI was associated with more persistent ST-segment elevation (58% vs 13%; p=0.005), which aspiration thrombectomy did not improve.
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