title: Relation between neutrophil counts on admission, microvascular injury, and left ventricular functional recovery in patients with an anterior wall first acute myocardial infarction treated with primary coronary angioplasty.
abstract: Increased neutrophil counts have been associated with an increased risk of adverse clinical events after acute myocardial infarction (AMI). We examined the association of neutrophil counts on admission with degree of microvascular injury and left ventricular functional recovery after primary coronary angioplasty in AMI. We studied 116 patients with a first anterior wall AMI who underwent primary coronary angioplasty within 12 hours of onset. Patients were categorized into 3 groups based on initial neutrophil count: low (<5,000/mm(3)), intermediate (5,000 to 10,000/mm(3)), and high (>10,000/mm(3)). Coronary flow velocity parameters were assessed immediately after reperfusion using a Doppler guidewire. We defined severe microvascular injury as the presence of systolic flow reversal and a diastolic deceleration time <600 ms. Echocardiographic wall motion was analyzed before revascularization and 4 weeks after revascularization. In patients with a high neutrophil count, systolic flow reversal was more frequently observed, diastolic deceleration time was shorter, and coronary flow reserve was lower. By regression analysis, neutrophil count significantly correlated with diastolic deceleration time (r = -0.38, p <0.0001), coronary flow reserve (r = -0.33, p = 0.0004), and score for change in wall motion (r = -0.36, p = 0.0004). Multivariate analysis showed that neutrophil count on admission was an independent predictor of severe microvascular injury (odds ratio 2.94, p = 0.02). In conclusion, neutrophilia on admission is associated with impaired microvascular reperfusion and poor functional recovery after primary coronary angioplasty.
authors.affiliation: Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan. ttak@tokushima-med.jrc.or.jp
authors.forename: Takefumi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ohara
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Riyo
authors.initials: R
authors.lastname: Ogura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Miyajima
authors.forename: Ken-ichiro
authors.initials: K
authors.lastname: Yuba
authors.forename: Naoki
authors.initials: N
authors.lastname: Suzuki
authors.forename: Shinobu
authors.initials: S
authors.lastname: Hosokawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Kishi
authors.forename: Ryuji
authors.initials: R
authors.lastname: Ohtani
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D009504:Neutrophils; D020127:Recovery of Function; D016277:Ventricular Function, Left