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Successful reperfusion for acute ST elevation myocardial infarction is associated with a decrease in WBC count
Jaap Jan J Smit1, Jan Paul Ottervanger, Robbert J Slingerland
1Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands.
Insights
Successful reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) significantly decreases white blood cell (WBC) count. Impaired myocardial reperfusion after primary percutaneous coronary intervention (PCI) is linked to persistently elevated WBC counts.
Area of Science:
- Cardiology
- Hematology
- Interventional Cardiology
Background:
- Elevated white blood cell (WBC) count in ST-segment elevation myocardial infarction (STEMI) patients predicts adverse outcomes.
- The impact of successful reperfusion via primary percutaneous coronary intervention (PCI) on WBC count remains unclear.
Purpose of the Study:
- To investigate the association between successful reperfusion after primary PCI in STEMI patients and changes in WBC count.
- To determine if myocardial perfusion metrics correlate with WBC count reduction post-PCI.
Main Methods:
- Subanalysis of the On-TIME trial involving 364 STEMI patients undergoing primary PCI.
- WBC count measured at baseline, 6 hours, and 24 hours post-PCI.
- Angiographic assessment of reperfusion using TIMI flow and myocardial blush grade.
Main Results:
- Successful reperfusion (TIMI 3 flow) was associated with a significant decrease in WBC count.
- Unsuccessful PCI (TIMI < 3 flow) resulted in persistently elevated WBC counts.
- Improved myocardial blush and successful reperfusion independently predicted WBC count reduction.
Conclusions:
- Impaired myocardial reperfusion following primary PCI for STEMI is associated with sustained elevation of WBC count.
- Successful reperfusion therapy is crucial for mitigating the inflammatory response indicated by WBC levels in STEMI.
Background:
Elevated white blood cell (WBC) count on admission in patients with ST segment elevation myocardial infarction (STEMI) has been associated with an adverse prognosis. Whether successful reperfusion by primary percutaneous coronary intervention (PCI) is associated with a decrease in WBC count is unknown.
Methods:
In this subanalysis of the On-TIME trial, WBC count was measured on admission and 6 h and 24 h after primary PCI for STEMI (n = 364). Angiographic measurements of reperfusion, including TIMI-flow and myocardial blush grade, were compared with changes in WBC count.
Results:
Restoration of TIMI 3 flow by primary PCI was associated with a significant decrease in median WBC count (11.5 (9.7-14.2), 10.7 (9.0-12.5), 9.9 (8.5-11.5) at baseline, 6 h and 24 h), whereas after unsuccessful PCI (TIMI < 3 flow) WBC count remained elevated (12.5 (9.5-14.6), 12.1 (9.9-14.4), and 11.4 (9.2-15.2)). Improved myocardial blush was also related to a decrease in WBC count. After multivariate analysis, improved myocardial perfusion (TIMI 3 flow and myocardial blush grade 3) was an independent predictor of a decrease of WBC count after PCI.
Conclusion:
Impaired myocardial reperfusion after primary PCI for STEMI is associated with persistent WBC elevation.
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