CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy.
CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy.
Int J Cardiol. 2019 Sep 1;290:34-39. doi: 10.1016/j.ijcard.2019.05.002. Epub 2019 May 3.
Coronary no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) is associated with a poor clinical prognosis. Although its pathophysiology is not fully elucidated, a deregulated systemic inflammatory response plays an important role. Specifically, the relationship between age-associated differences in inflammatory markers and either no-reflow or mortality in STEMI patients undergoing primary percutaneous coronary intervention (pPCI) has never been investigated.
We retrospectively enrolled 625 consecutive STEMI patients undergoing pPCI for whom a complete laboratory inflammatory pattern was available. Routinely blood measured laboratory parameters were collected at the moment of admission. No reflow was defined as Thrombolysis in Myocardial Infarction (TIMI) flow-grade lower than 3. The population was divided into two groups using a cut-off centered at 65 years. Compared to younger patients, elderly patients had higher mean values of fibrinogen, brain natriuretic peptide (BNP), leukocytes, neutrophil-to-lymphocyte ratio (NLR), C reactive protein/albumin ratio (CAR). Conversely, lymphocyte count and albumin levels were higher in young patients. In elderly patients, the values of NLR, CAR as well as leukocytes, fibrinogen and neutrophils were associated with no-reflow, while in young patients only BNP value was associated. At multivariate Cox regression analysis, only BNP and NLR resulted as independent predictors of all-cause mortality in the whole population and in elderly patients.
Elderly STEMI patients on admission had a higher acute pro-inflammatory profile than young patients, associated to coronary no-reflow and mortality outcome. These results suggest that a different therapeutic approach between elderly and young STEMI patients should be agreed.
ST 段抬高型心肌梗死（STEMI）中的冠状动脉无复流现象与不良临床预后相关。尽管其病理生理学尚未完全阐明，但系统炎症反应失调起着重要作用。具体来说，在接受直接经皮冠状动脉介入治疗（pPCI）的 STEMI 患者中，年龄相关的炎症标志物差异与无复流或死亡率之间的关系尚未得到研究。
我们回顾性纳入了 625 例连续接受 pPCI 的 STEMI 患者，这些患者的完整实验室炎症模式均可获得。在入院时采集常规血液测量的实验室参数。无复流定义为心肌梗死溶栓（TIMI）血流分级低于 3 级。人群分为两组，以 65 岁为中心的截断值。与年轻患者相比，老年患者的纤维蛋白原、脑钠肽（BNP）、白细胞、中性粒细胞与淋巴细胞比值（NLR）、C 反应蛋白/白蛋白比值（CAR）的平均值更高。相反，年轻患者的淋巴细胞计数和白蛋白水平更高。在老年患者中，NLR、CAR 以及白细胞、纤维蛋白原和中性粒细胞的值与无复流相关，而在年轻患者中仅 BNP 值与无复流相关。多变量 Cox 回归分析显示，在全人群和老年患者中，仅 BNP 和 NLR 是全因死亡率的独立预测因子。
入院时的老年 STEMI 患者比年轻患者具有更高的急性促炎表型，与冠状动脉无复流和死亡率相关。这些结果表明，老年和年轻 STEMI 患者之间应采用不同的治疗方法。
