Association between baseline neutrophil count, clopidogrel therapy, and clinical and angiographic outcomes in patients with ST-elevation myocardial infarction receiving fibrinolytic therapy.
OBJECTIVE
To investigate the association between neutrophil count, outcomes, and benefit of clopidogrel therapy in ST-elevation myocardial infarction (STEMI).


RESULTS
Baseline neutrophil count was measured in 2865 patients in CLARITY-TIMI 28, a randomized trial of clopidogrel vs. placebo in STEMI patients undergoing fibrinolysis. Angiography was performed at 2-8 days following enrollment. Analyses were adjusted for demographics, time from symptom onset, Killip class, peak CK-MB, and therapies received. A baseline neutrophil count in the highest quartile was independently associated with the risk of cardiovascular (CV) death [adj (adjusted) OR (odds ratio) 5.8, P < 0.001] and congestive heart failure (adj OR 3.0, P = 0.009) at 30 days. Patients with higher neutrophil counts were less likely to achieve complete ST-segment resolution (adj OR 0.76, P = 0.03) or TIMI myocardial perfusion grade 2/3 (adj OR 0.71, P = 0.017). Clopidogrel had a lesser effect on reducing the odds of a closed infarct-related artery, or death or MI before angiography, in patients with a neutrophil count above the median (adjusted OR 0.83, 0.61-1.13) vs. in those below the median (adjusted OR 0.46, 0.33-0.64) (Pinteraction = 0.008).


CONCLUSIONS
In patients with STEMI, higher baseline neutrophil count is associated with worse angiographic findings and increased CV mortality, as well as a diminished benefit of clopidogrel.
O'Donoghue
Michelle
M
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, 350 Longwood Avenue, 1st Floor, Boston, MA 02115, USA. modonoghue@partners.org
Morrow
David A
DA
Cannon
Christopher P
CP
Guo
Wei
W
Murphy
Sabina A
SA
Gibson
C Michael
CM
Sabatine
Marc S
MS
D000077144:Clopidogrel; D017023:Coronary Angiography; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D009504:Neutrophils; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015912:Thrombolytic Therapy / Q000379:methods*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine