Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Eur J Clin Invest. 2014;44(3):257-65. doi: 10.1111/eci.12228. Epub 2014 Jan 20.
Recent 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.
In 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.
The median follow-up time was 39 months interquartile range (IQR 21·4-54·6 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 0·25 Giga/l. CS neutrophil accumulation occurred in 195 patients (47%) and was independently associated with mortality (hazard ratio 1·88 (95%CI 1·02-3·41, P = 0·043)). In patients with CS neutrophil accumulation, 1-year mortality (10·8% vs. 7·2%) and 4-year mortality (19·8% vs. 10·4%) were markedly increased compared with patients without local neutrophil accumulation. Concordance index for CS neutrophil accumulation and mortality was 0·64 (95% CI 0·51-0·77; P = 0·035). Patients with CS neutrophil accumulation had significantly more often nonobstructive lesions compared with patients without neutrophil accumulation (32·6% vs. 22·4%; P = 0·024).
Neutrophil accumulation at the coronary culprit lesion site is a strong and independent predictor of mortality in patients with ACS/AMI.
最近的数据表明，急性冠状动脉综合征（ACS）和急性心肌梗死（AMI）的特点是血栓形成中有一个炎症亚群。我们之前描述过在冠状动脉罪犯病变部位中性粒细胞的积累。在这项工作中，我们评估了 AMI 患者罪犯部位（CS）中性粒细胞积累对长期死亡率的预后价值。
在这项前瞻性研究中，417 例 AMI 患者在经皮冠状动脉介入治疗的血栓切除术术后入组。使用时间依赖性接收者操作特征曲线分析计算 CS 中性粒细胞积累预测 4 年全因死亡率的最佳截断值。
中位随访时间为 39 个月（四分位距 21.4-54.6 个月），随访时间为 1217 患者年。CS 中性粒细胞积累（罪犯中性粒细胞计数与系统中性粒细胞计数之差）的截断值为 0.25Giga/L。195 例患者（47%）出现 CS 中性粒细胞积累，与死亡率独立相关（风险比 1.88（95%CI 1.02-3.41，P=0.043））。在有 CS 中性粒细胞积累的患者中，1 年死亡率（10.8%比 7.2%）和 4 年死亡率（19.8%比 10.4%）明显高于无局部中性粒细胞积累的患者。CS 中性粒细胞积累和死亡率的一致性指数为 0.64（95%CI 0.51-0.77；P=0.035）。与无中性粒细胞积累的患者相比，有 CS 中性粒细胞积累的患者的非阻塞性病变明显更多（32.6%比 22.4%；P=0.024）。
冠状动脉罪犯病变部位中性粒细胞的积累是 ACS/AMI 患者死亡率的一个强有力且独立的预测因素。
