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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Effect of Aspiration Thrombectomy on Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction With an
Hye Young Lee1, Jeong Hoon Kim, Byung Ok Kim
1Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Insights
High neutrophil counts in ST-elevation myocardial infarction (STEMI) patients indicate worse microvascular dysfunction after primary percutaneous coronary intervention (PCI). Aspiration thrombectomy (AT) did not improve this dysfunction in STEMI patients with elevated neutrophils.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers in Cardiovascular Disease
Background:
- ST-elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Elevated neutrophil counts in STEMI patients are linked to microvascular dysfunction and poorer outcomes.
- Aspiration thrombectomy (AT) is an adjunctive therapy during primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the impact of elevated neutrophil counts on microvascular dysfunction in STEMI patients undergoing primary PCI.
- To determine if AT can mitigate microvascular dysfunction in STEMI patients with high neutrophil counts.
Main Methods:
- Seventy STEMI patients undergoing primary PCI were stratified into neutrophil count tertiles.
- Microvascular dysfunction was assessed using TIMI myocardial perfusion (TMP) grade and ST-segment resolution.
- Clinical outcomes, including major adverse cardiac events (MACE), were tracked for 9 months.
Main Results:
- Higher neutrophil counts correlated with increased microvascular dysfunction, evidenced by lower TMP grades and more persistent ST-segment elevation.
- No significant difference in post-procedural TIMI flow or 9-month MACE rates was observed between neutrophil groups.
- In the AT subgroup, increasing neutrophil counts showed a trend towards less frequent TMP grade 3 and more persistent ST-segment elevation.
Conclusions:
- Elevated neutrophil counts at STEMI presentation are associated with greater microvascular dysfunction post-primary PCI.
- Aspiration thrombectomy does not appear to improve microvascular dysfunction in STEMI patients with high neutrophil counts.
Background And Objectives:
Aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI) is an effective adjunctive therapy for ST-segment elevation myocardial infarction (STEMI). An elevated neutrophil count in STEMI is associated with microvascular dysfunction and adverse outcomes. We evaluated whether AT can improve microvascular dysfunction in patients with STEMI and an elevated neutrophil count.
Subjects And Methods:
Seventy patients with STEMI undergoing primary PCI from August 2007 to February 2009 in our institution were classified by tertiles of neutrophil count on admission (<5,300/mm(3), 5,300-7,600/mm(3), and >7,600/mm(3)). The angiographic outcome was post-procedural thrombolysis in myocardial infarction (TIMI) flow grade. Microvascular dysfunction was assessed by TIMI myocardial perfusion (TMP) grade and ST-segment resolution on electrocardiography 90 minutes after PCI. The clinical outcome was major adverse cardiac event (MACE), defined as cardiac death, re-infarction, and target lesion revascularization at 9 months.
Results:
There were no significant differences in the clinical characteristics and pre- and post-procedural TIMI flow grades between the neutrophil tertiles. As the neutrophil count increased, a lower tendency toward TMP grade 3 (83% vs. 52% vs. 54%, p=0.06) and more persistent residual ST-segment elevation (>4 mm: 13% vs. 26% vs. 58%, p=0.005) was observed. The 9-month MACE rate was similar between the groups. On subgroup analysis of AT patients (n=52) classified by neutrophil tertiles, the same tendency toward less frequent TMP grade 3 (77% vs. 56% vs. 47%, p=0.06) and persistent residual ST-segment elevation (>4 mm: 12% vs. 28% vs. 53%, p=0.05) was observed as neutrophil count increased.
Conclusion:
A higher neutrophil count at presentation in STEMI is associated with more severe microvascular dysfunction after primary PCI, which is not improved with AT.
