Using eosinophil response to predict cardiovascular outcomes in patients with ST- elevation myocardial infarction who
Joyce Lim1,2, Trent Williams1,2,3, Lucy Murtha2,3
1Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
Insights
Eosinophil response after ST-elevation myocardial infarction (STEMI) predicts short-term major adverse cardiovascular events (MACE). A decrease in eosinophils greater than -0.05 × 10^9/L is highly sensitive for predicting 30-day MACE.
Area of Science:
- Cardiology
- Immunology
- Biomarker Discovery
Background:
- Eosinophils are involved in inflammation post-STEMI.
- The predictive value of eosinophils for MACE is not well-established.
Purpose of the Study:
- To assess the predictive capability of eosinophil response for 30-day and 1-year MACE after primary PCI in STEMI patients.
Main Methods:
- Retrospective cohort study of 366 STEMI patients undergoing PCI.
- Eosinophil response defined as change in cell count from admission to 48h post-PCI.
- ROC curves and multivariate logistic regression used to analyze MACE prediction.
Main Results:
- An eosinophil response > -0.05 × 10^9/L predicted 30-day MACE with 83% sensitivity and 98% negative predictive value.
- This eosinophil change was associated with a threefold increased likelihood of 30-day MACE (OR 3.1).
- No significant prediction for 1-year MACE was observed.
Conclusions:
- Eosinophil response at 48h post-PCI is a sensitive predictor of 30-day MACE in STEMI patients.
- Absence of a significant eosinophil decrease has a high negative predictive value for 30-day MACE.
Objective:
Eosinophils have been implicated in mediating the inflammatory response after ST-elevation myocardial infarction (STEMI), but its role as a biomarker predicting major adverse cardiovascular events (MACE) remains unclear. We aimed to evaluate the predictive value of eosinophil response on 30-day and 1-year MACE post primary percutaneous coronary intervention (PCI) after STEMI.
Methods:
Single centre retrospective cohort study of STEMI patients undergoing PCI. Eosinophil response was defined as the change in peripherally circulating eosinophils cell count at admission minus 48 h post primary PCI. Primary endpoints were 30-day and 1-year MACE. Receiver operating characteristic (ROC) curves were created to identify optimal cut-off predicting MACE. Multivariate logistic regression analyses were used to determine if the ROC cut-off was an independent predictor of MACE.
Results:
Of the 366 patients in this study (median age 61 years [53.0-71.0]; 267 males [73 %]), 41 patients (11.2 %) and 78 patients (21.3 %) developed MACE at 30-days and 1-year. The optimal ROC curve cut-off predicting MACE was an eosinophil response of greater than -0.05 × 10^9/L (ΔEos > -0.05). It had a sensitivity, specificity, and positive and negative predictive value of 83, 39, 6 and 98 % for 30-day MACE, and 74, 39, 19 and 88 % for 1-year MACE. An ΔEos > -0.05 change was associated with a threefold higher likelihood of MACE at 30-days (OR 3.1, 95 % CI 1.04-9.07, p=0.042), but not 1-year.
Conclusion:
An eosinophil response of -0.05 × 10^9L at 48 h following primary PCI post STEMI is highly sensitive at predicting 30-day MACE, and in its absence, holds a high negative predictive value.
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