Prognostic value of culprit site neutrophils in acute coronary syndrome.
BACKGROUND
Recent data suggest that acute coronary syndromes (ACS) and acute myocardial infarction (AMI) are characterized by an inflammatory subset of thrombosis. We have previously described the accumulation of neutrophils at the coronary culprit lesion site. In this work, we assessed the prognostic value of culprit site (CS) neutrophil accumulation on long-term mortality in patients with AMI.


METHODS
In this prospective study, 417 AMI patients were enrolled after thrombectomy during primary percutaneous coronary intervention. The optimal cut-off for CS neutrophil accumulation for predicting 4-year all-cause mortality was calculated using time-dependent receiver operator characteristic curve analyses.


RESULTS
The median follow-up time was 39 months interquartile range (IQR 21·4-54·6 months) corresponding to 1217 patient years of follow-up. The cut-off for CS neutrophil accumulation (difference between culprit neutrophil counts and systemic neutrophil counts) was 0·25 Giga/l. CS neutrophil accumulation occurred in 195 patients (47%) and was independently associated with mortality (hazard ratio 1·88 (95%CI 1·02-3·41, P = 0·043)). In patients with CS neutrophil accumulation, 1-year mortality (10·8% vs. 7·2%) and 4-year mortality (19·8% vs. 10·4%) were markedly increased compared with patients without local neutrophil accumulation. Concordance index for CS neutrophil accumulation and mortality was 0·64 (95% CI 0·51-0·77; P = 0·035). Patients with CS neutrophil accumulation had significantly more often nonobstructive lesions compared with patients without neutrophil accumulation (32·6% vs. 22·4%; P = 0·024).


CONCLUSIONS
Neutrophil accumulation at the coronary culprit lesion site is a strong and independent predictor of mortality in patients with ACS/AMI.
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Klaus
K
Distelmaier
Max-Paul
MP
Winter
Florian
F
Dragschitz
Bassam
B
Redwan
Andreas
A
Mangold
Andreas
A
Gleiss
Thomas
T
Perkmann
Gerald
G
Maurer
Christopher
C
Adlbrecht
Irene M
IM
Lang
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000473:pathology*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology*; D009504:Neutrophils / Q000473:pathology*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011446:Prospective Studies; D017131:Thrombectomy; D013927:Thrombosis / Q000401:mortality / Q000473:pathology*
Acute coronary syndrome; neutrophils; prognosis