Ishihara Masaharu, Inoue Ichiro, Kawagoe Takuji, Shimatani Yuji, Kurisu Satoshi, Hata Takaki, Mitsuba Naoya, Kisaka Tomohiko
Department of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan.
Int J Cardiol. 2005 Aug 18;103(2):150-5. doi: 10.1016/j.ijcard.2004.08.046.
Elevation of white blood cell (WBC) count at admission is associated with adverse outcome after acute myocardial infarction (AMI). Prodromal angina, by the mechanism of ischemic preconditioning, improves left ventricular (LV) function and survival after reperfusion therapy in patients with AMI. Recent experimental studies have reported that preconditioning has anti-inflammatory effect.
This study consisted of 598 patients with first anterior wall AMI who underwent coronary angiography within 12 h after symptom onset. WBC count was measured at the time of hospital admission. Prodromal angina was defined as angina occurring within 24 h before the onset of AMI. Serial measurements of LV ejection fraction (EF) were obtained before reperfusion therapy and before discharge in 421 patients (71%).
High WBC count (>10.2 x 103/mm3, n=297) was associated with higher 30-day mortality (8% vs. 4%, p=0.02) and lower predischarge LVEF (51+/-15% vs. 57+/-14%, p<0.001), although there was no significant difference in acute LVEF (47+/-10% vs. 49+/-11%, p=0.07). High WBC count was an independent predictor of 30-day mortality (p=0.009) and predischarge LVEF (p=0.002). Prodromal angina was associated with lower 30-day mortality (3% vs. 7%, p=0.02) and preserved predischarge LVEF (57+/-15% vs. 53+/-14%, p=0.006). Patients with prodromal angina had lower WBC count (10.0+/-3.3 x 10(3)/mm3 vs. 11.0+/-3.9 x 10(3)/mm3, p=0.001) and prodromal angina was an independent predictor of WBC count (p<0.001).
Elevation of WBC count and lack of prodromal angina were associated with impaired LV function and mortality after reperfusion in patients with AMI. Prodromal angina might have contributed to favorable outcome after AMI through its anti-inflammatory effect.
急性心肌梗死（AMI）患者入院时白细胞（WBC）计数升高与不良预后相关。前驱性心绞痛通过缺血预处理机制，可改善AMI患者再灌注治疗后的左心室（LV）功能和生存率。最近的实验研究报道，预处理具有抗炎作用。
本研究纳入了598例首发前壁AMI患者，这些患者在症状发作后12小时内接受了冠状动脉造影。入院时测量WBC计数。前驱性心绞痛定义为AMI发作前24小时内出现的心绞痛。在421例患者（71%）中，于再灌注治疗前和出院前连续测量左心室射血分数（EF）。
高WBC计数（>10.2×10³/mm³，n = 297）与30天死亡率较高（8%对4%，p = 0.02）和出院前较低的左心室射血分数（51±15%对57±14%，p<0.001）相关，尽管急性左心室射血分数无显著差异（47±10%对49±11%，p = 0.07）。高WBC计数是30天死亡率（p = 0.009）和出院前左心室射血分数（p = 0.002）的独立预测因素。前驱性心绞痛与较低的30天死亡率（3%对7%，p = 0.02）和出院前保留的左心室射血分数（57±15%对53±14%，p = 0.006）相关。有前驱性心绞痛的患者WBC计数较低（10.0±3.3×10³/mm³对11.0±3.9×10³/mm³，p = 0.001），且前驱性心绞痛是WBC计数的独立预测因素（p<0.001）。
AMI患者再灌注后WBC计数升高和无前驱性心绞痛与左心室功能受损和死亡率相关。前驱性心绞痛可能通过其抗炎作用对AMI后的良好预后有贡献。
