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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Prognostic value of culprit site neutrophils in acute coronary syndrome
Klaus Distelmaier1, Max-Paul Winter, Florian Dragschitz
1Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria; Division of Endocrinology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Insights
Neutrophil accumulation at the coronary culprit lesion site predicts long-term mortality in acute myocardial infarction (AMI) patients. This inflammatory marker is a strong, independent predictor of death, highlighting its prognostic value.
Area of Science:
- Cardiology
- Immunology
- Thrombosis Research
Background:
- Acute coronary syndromes (ACS) and acute myocardial infarction (AMI) involve an inflammatory component of thrombosis.
- Previous work identified neutrophil accumulation at the coronary culprit lesion site.
Purpose of the Study:
- To evaluate the prognostic significance of culprit site (CS) neutrophil accumulation on long-term mortality in AMI patients.
Main Methods:
- Prospective study of 417 AMI patients post-thrombectomy during primary percutaneous coronary intervention.
- Time-dependent receiver operator characteristic curve analyses determined the optimal cut-off for CS neutrophil accumulation predicting 4-year mortality.
Main Results:
- Neutrophil accumulation at the culprit site (CS neutrophil accumulation > 0.25 Giga/l) occurred in 47% of patients and independently predicted mortality (HR 1.88).
- Patients with CS neutrophil accumulation had significantly higher 1-year (10.8% vs 7.2%) and 4-year mortality (19.8% vs 10.4%).
- CS neutrophil accumulation was associated with nonobstructive lesions (32.6% vs 22.4%).
Conclusions:
- Neutrophil accumulation at the coronary culprit lesion site is a robust and independent predictor of mortality in ACS/AMI patients.
- This finding underscores the role of inflammation in AMI prognosis.
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.
Materials And 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.
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