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Prolonged Inflammation Associates With Greater Infarct Size and Poor Outcome After ST-Segment Elevation Myocardial

Christian Graesser1, Johannes Krefting2, Marius Schwab3

  • 1German Heart Centre Munich, Department of Cardiology, TUM University Hospital, Technical University of Munich, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany; Department of Internal Medicine III - Cardiology and Angiology, Saarland University Medical Center, Homburg/Saar, Germany.

JACC. Basic to Translational Science
|June 3, 2026
PubMed

Insights

Persistent high white blood cell counts after ST-elevation myocardial infarction (STEMI) indicate ongoing inflammation. This sustained leukocytosis is linked to larger infarct size, poorer heart function, and increased mortality risk.

Area of Science:

  • Cardiovascular Medicine
  • Immunology
  • Biomarkers

Background:

  • Acute myocardial infarction (MI) triggers a systemic inflammatory response.
  • The prognostic significance of persistent inflammation post-MI remains unclear.
  • Leukocyte counts typically normalize within days, but sustained elevation warrants investigation.

Purpose of the Study:

  • To investigate the relationship between sustained leukocytosis and clinical outcomes after ST-elevation myocardial infarction (STEMI).
  • To determine if elevated leukocyte counts correlate with infarct size and left ventricular function.
  • To identify persistent inflammation as a potential negative prognostic marker.

Main Methods:

  • Analysis of over 1,700 STEMI patients treated with primary percutaneous coronary intervention.
  • Stratification of patients based on leukocyte counts at admission and day 3.
  • Assessment of infarct size, left ventricular function, and mortality rates.
  • Monocyte RNA sequencing and murine MI models to study immune response.

Main Results:

  • High leukocyte counts on day 3 post-STEMI were associated with larger infarct size.
  • Persistent leukocytosis correlated with worse left ventricular function and increased 1- and 5-year mortality.
  • Declining leukocyte counts indicated better recovery, while persistent elevation predicted poorer outcomes.

Conclusions:

  • Persistent inflammation, indicated by elevated day 3 leukocyte counts, is linked to adverse cardiac remodeling and higher mortality post-STEMI.
  • Unresolved inflammation serves as a negative prognostic indicator.
  • Targeting persistent inflammation may offer a therapeutic strategy for STEMI patients.
Abstract

Keywords:
STEMIinflammationleukocytesresolution of inflammationrisk stratification

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