Prognostic value of neutrophil response in the era of acute myocardial infarction mechanical reperfusion.
BACKGROUND
In ST-segment elevation myocardial infarction (STEMI) patients treated with primary angioplasty, neutrophil response and its prognostic significance are not entirely understood.


METHODS
We retrospectively studied 305 consecutive and non-selected STEMI patients. They were divided into three groups according to the maximum neutrophil percentage in the first 48 hours. We compared baseline demographic characteristics, coronary disease risk factors, cardiac history, clinical presentation, therapeutics administered and clinical evolution. We then assessed survival in the three groups and determined predictors of 30-day mortality. Group 1 (G1) had a mean age of 57 +/- 14 years and showed mean neutrophilia of 73.3%, Group 2 (G2) 61 +/- 13 years and 79.9%, and Group 3 (G3) 66 +/- 13 years and 84.2%. We compared outcomes and 30-day mortality between the groups.


RESULTS
Mean age rose with increased neutrophil response. There were no statistically significant baseline differences between the groups except for more smokers in Groups 1 and 2, and more patients presenting with Killip class > or = 2 and fewer with uncomplicated evolution in Group 3. During 30-day follow-up there were 19 deaths (G1=1, G2=3 and G3=15). In univariate analysis mortality predictors were age > or = 75 years, anterior STEMI, maximum creatinine kinase > or = 2500 UI/L, culprit lesion in proximal anterior descending artery, incomplete revascularization, Killip > or = 2 at presentation, and being in G3. After multivariate regression analysis independent predictors were age > or = 75 years, incomplete revascularization and being in G3.


CONCLUSIONS
In myocardial infarction patients undergoing mechanical revascularization, an intense neutrophil response (routinely, easily and inexpensively assessed) is related to worse short-term prognosis.
Fiarresga
António José
AJ
Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal. a.fiarresga@netcabo.pt
Ferreira
Rui Cruz
RC
Feliciano
Joana
J
Timóteo
Ana Teresa
AT
Pelicano
Nuno
N
de Sousa
Lídia
L
de Ferreira
Maria Lurdes
ML
Gonçalves
José Maria
JM
Quininha
Jorge
J
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000276:immunology* / Q000601:surgery*; D015425:Myocardial Reperfusion / Q000379:methods*; D009504:Neutrophils / Q000502:physiology*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors