Association of Non-Specific Inflammatory Activation With Early Mortality in Patients With ST-Elevation Acute Coronary Syndrome Treated With Primary Angioplasty

Abstract

nflammatory activation is inherently related to the development and clinical course of coronary artery disease, 1,2 and regarding non-specific inflammatory indices, baseline leukocytosis has been previously related to increased mortality in unselected cases of ST-elevation myocardial infarction (STEMI) treated with either primary percutaneous coronary intervention (PCI) or thrombolysis. [3][4][5] From among the differential components neutrophils (Ns), lymphocytes (Ls) and the N to L ratio have been also associated with clinical outcomes in STEMI patients. [6][7][8][9][10] With respect to C-reactive protein (CRP), thrombolytic studies show conflicting results [11][12][13] and the data regarding patients treated with primary PCI are limited and do not examine early results in cases of STEMI. [14][15][16][17] Recently, the impact of inflammatory activation on direct worsening of acute clinical outcome in acute coronary syndromes (ACS) has been opposed to stable conditions in coronary disease, highlighting distinct pathomechanisms for both conditions. 1,2 Therefore, the longer term follow-up studies associate inflammatory indices with clinical outcome Circulation Journal Vol.72, February 2008 of STEMI, the more events may be attributed to atherosclerosis progression, leading to dilution and misinterpretation of the true significance of inflammation in the acute phase of STEMI. Moreover, in the advent of conceivable anti-CRP therapy in STEMI, precise determination of its role in humans becomes increasingly important. 18 Therefore, in the present study we investigated the relationship of non-specific inflammatory activation and the immediate outcome of STEMI treated with primary angioplasty. Methods Study PopulationOur study group consisted of 1,078 unselected prospective registry patients enrolled during 2.4 years following April 2002 (with exclusion of 120 patients admitted during a hospital laboratory refurbishment period when routine assay of high-sensitivity CRP (hs-CRP) was not performed off-hours). A predefined set of data for consecutive, unselected patients with STEMI and time from pain onset to admission up to 12 h who are admitted for primary angioplasty have been recorded in a prospective hospital registry since February 2001. 3 STEMI is defined as ST-elevation of ≥0.1 mV in >1 limb leads or ≥0.2 mV in contiguous chest leads or left bundle branch block on presentation.Per institutional requirements, since April 2002 all the patients on admission and prior to any coronary procedures routinely have blood drawn for hs-CRP as well as for differential and white blood cell (WBC) count. In all patients The association of inflammatory markers with mortality in ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) remains controversial, so in the present study the relationships of high-sensitivity C-reactive protein (hs-CRP), total white blood cell (WBC) count, neutrophil (N) and lymphocyte (L) counts and the N/L ratio with occurrence of in-hospital mortality w...

Enhanced Expression of the S100A8/A9 Complex in Acute Myocardial Infarction Patients

“…This global activation is partly evidenced by elevated CRP levels and elevated leukocyte counts. 19, 20 Thus, it is possible, as an alternate explanation, that the bulk of the circulating S100A8/A9 was derived from the increased numbers of activated circulating neutrophils and macrophages.…”

High-Sensitivity C-Reactive Protein as a Predictor of Cardiovascular Events after ST-Elevation Myocardial Infarction

“…However, these studies were limited by a small sample size of 230 and 146 patients, respectively, and failure to explicitly list potential exclusion criteria, such as the use of NSAIDs and presence of inflammatory diseases. Kruk et al 28 also reported that hs-CRP was predictive of in-hospital death without mentioning the exclusion criteria in their article. …”

“…Selection biases and heterogeneity of the reperfusion modalities are some of the limitations of the different studies. In the setting of primary percutaneous coronary intervention (pPCI), the data available are controversial and scarce, particularly with regard to short-term events 28 . Moreover, risk scores with a strong prognostic ability, particularly Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores, have been broadly used with the aim of early risk stratification 29,30 .…”

Prospective Comparison of the 5 Most Popular Risk Scores in Clinical Use for Unselected Patients With Acute Coronary Syndrome

“…20, 21 The model does not include inflammatory markers either (ie, highsensitivity C-reactive protein, total white blood cell count), which were shown to predict early outcomes in STEMI patients treated with primary PCI. 22 The potential inclusion of these factors in future studies leaves an option for further improvement of the model. However, it is worth underlining that the laboratory results are usually available at the later stage of the hospital stay, up to 8 h, which may increase the delay in decision making.…”