Prognostic value of circulating dead monocytes in patients with acute st-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
OBJECTIVE
This study tested the hypothesis that the level of apoptotic and necrotic peripheral blood mononuclear cells (PBMCs) is a predictor of the 30-day combined major adverse clinical outcome (MACO) [defined as advanced congestive heart failure (CHF), a high Killip score, or 30-day mortality] in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).


METHODS
Between April 2009 and January 2010, 98 patients undergoing primary PCI were assessed for both apoptotic and necrotic PBMCs (apoptotic cells are referred to as annexin V+/propidium iodide- and necrotic cells are defined as annexin V+/propidium iodide+) using flow cytometry 24 h after STEMI. Patients with higher (≥ 3.2%) and lower (<3.2%) levels of necrotic cells were categorized into group 1 (n = 40) and group 2 (n = 58), respectively, according to the ROC curve method.


RESULTS
Higher incidences of advanced CHF and a high Killip score were noted in group 1 patients (p < 0.0001). Moreover, the peak level of creatine phosphokinase was higher in group 1 (p < 0.0001), whereas the left ventricular ejection fraction was lower in group 1 than in group 2 (p < 0.001). Multivariate analysis revealed that high necrotic cells (≥ 3.2%) was the strongest independent predictor of 30-day MACO (p = 0.001).


CONCLUSIONS
A high level of necrotic cells (PBMCs) may serve as a useful biomarker for predicting 30-day MACO in patients with STEMI undergoing primary PCI.
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Kaohsiung, Taiwan, ROC.
Tzu-Hsien
TH
Tsai
Yu-Chun
YC
Lin
Cheuk-Kwan
CK
Sun
Sheng-Ying
SY
Chung
Han-Tan
HT
Chai
Cheng-Hsu
CH
Yang
Shyh-Ming
SM
Chen
Chi-Ling
CL
Hang
Chien-Jen
CJ
Chen
Sarah
S
Chua
Chiung-Jen
CJ
Wu
Steve
S
Leu
Hon-Kan
HK
Yip
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D016923:Cell Death / Q000276:immunology; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology*; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors
D015415:Biomarkers