[Hematocrit as an indicator for coronary intervention in patients with acute myocardial infarction]
Fumitaka Inoue1, Toshio Hashimoto, Hisayuki Tabuse
1Nara Prefectural Emergency and Critical Care Center, Hiramatsu 1-30-1, Nara, Nara 631-0846.
Insights
High hematocrit levels in acute myocardial infarction patients correlate with more difficult primary coronary interventions due to increased thrombus formation. Measuring hematocrit is crucial for guiding intervention strategies in these critical cases.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Hematology
Background:
- Primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) can be challenging, particularly with significant intracoronary thrombus.
- Elevated hematocrit levels have been anecdotally linked to increased thrombus burden during AMI.
Purpose of the Study:
- To investigate the association between high hematocrit score and the difficulty of primary PCI in patients experiencing AMI.
- To determine if hematocrit levels predict the presence of massive intracoronary thrombus and procedural complexity.
Main Methods:
- Forty-five AMI patients were stratified into high (hematocrit >= 48%) and low (< 48%) hematocrit groups.
- Key procedural metrics including intervention time, balloon inflations, thrombus presence, need for adjunctive thrombolysis, intra-aortic balloon pumping, and Thrombolysis in Myocardial Infarction (TIMI) 3 flow were compared.
- Correlation analyses explored relationships between hematocrit and intervention time or balloon inflations.
Main Results:
- The high hematocrit group exhibited significantly longer intervention times (2.7 vs 1.4 hr), more balloon inflations (12 vs 3), 100% incidence of massive thrombus, and higher rates of adjunctive thrombolysis (63%) and intra-aortic balloon pumping (63%).
- Conversely, TIMI 3 flow was markedly lower in the high hematocrit group (25% vs 95%).
- Positive correlations were found between hematocrit and both intervention time (r2=0.16) and balloon inflations (r2=0.19).
Conclusions:
- High hematocrit on admission in AMI patients is associated with a greater likelihood of persistent massive intracoronary thrombus, complicating primary PCI.
- Measurement of hematocrit score should be incorporated into the interventional strategy for AMI patients undergoing primary coronary intervention.
Objectives:
Primary coronary intervention in patients with acute myocardial infarction complicated by persistent massive intracoronary thrombus is frequently difficult. Higher incidence of thrombus formation is associated with high hematocrit score. This study investigated the relationship between high hematocrit score and primary coronary intervention in patients with acute myocardial infarction.
Methods:
Forty-five patients with acute myocardial infarction were divided into two groups according to hematocrit score on admission, the high hematocrit group (hematocrit > or = 48%, n = 8) and the low hematocrit group (hematocrit < 48%, n = 37). Time period required for coronary intervention (intervention time), number of balloon inflations, presence of persistent massive intracoronary thrombus, need for adjunctive intracoronary thrombolysis, need for intraaortic balloon pumping and achieved rate of Thrombolysis in Myocardial Infarction (TIMI) 3 were compared between the two groups. The relationships between hematocrit and intervention time or number of balloon inflations were also investigated.
Results:
Intervention time (2.7 +/- 1.4 vs 1.4 +/- 0.7 hr, p = 0.0003), number of balloon inflations (12 +/- 9 vs 3 +/- 2 times, p = 0.0001), presence of persistent massive intracoronary thrombus (100% vs 5%, p < 0.0001), intracoronary thrombolysis (63% vs 3%, p = 0.0003), and intraaortic balloon pumping (63% vs 14%, p = 0.0092) were significantly higher in the high hematocrit group. However, the rate of TIMI 3 (25% vs 95%, p < 0.0001) was significantly lower in the high hematocrit group. The relationships between hematocrit and intervention time (r2 = 0.16, p = 0.0033), and hematocrit and number of balloon inflations (r2 = 0.19, p = 0.0015) showed positive correlations.
Conclusions:
Primary coronary intervention for patients with acute myocardial infarction showing high hematocrit score on admission is likely to be difficult due to the presence of persistent massive intracoronary thrombus. Therefore, coronary interventional strategy for intracoronary thrombolysis in patients with acute myocardial infarction should include measurement of hematocrit score.
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