Extend of coronary lesion, in-hospital complications in patients with STEMI, treated with PCI and high levels of CD14++CD16+ monocytes subpopulation

Abstract

Aims Acute myocardial infarction with the ST elevation (STEMI) is accompanied by the development of an inflammatory reaction, in particular, activation of monocytes. To date, the relationship between the levels and dynamics of monocyte populations in patients with STEMI and the prevalence of coronary atherosclerosis on the one hand (and with the clinical course of the disease, on the other hand) is not well understood. Methods and results The 50 STEMI patients (pts) were studied prospectively. All the pts underwent the PCI (alone, or followed by angioplasty/stenting) and have the monocytes (Mc) population analysis data obtained at 1st and 7th–10th days. According to the angiography data, pts were divided into three groups: “single-vessel lesion” (group 1, n=13), “two-vessel lesion” (group 2, n=14) and “three-vessel lesion” (group 3, n=23). There was an in-hospital increase in CD14++CD16-, CD14++CD16+ and CD14+CD16++ populations of Mc in 3rd group (+5%, +43% and +44%, respectively, p<0.05 for all), whereas in subgroups 1 and 2 there was an increase in CD14+CD16++ population (+70% in group 1, p<0.05 and +90% in group 2, p<0.001), without significant dynamics of CD14++CD16− and CD14++CD16+ populations. In addition, there was an increase in the CD14+CD16++ population only in pts with 1–3 coronary lesions (+72%, p<0.001 versus −12% of decrease in pts with more than 3 lesions, p>0.1). The number of CD14++CD16+ Mc on day 1 of STEMI correlated positively with levels of C-reactive protein (C-RP, r=0.34, p<0.05), erythrocyte sedimentation rate (ESR, r=0.39, p<0.01), and with left ventricle (LV) end-systolic volume (r=0.33, p<0.05) and negatively – with LV ejection fraction (r=−0.22, p<0.1), while there were only slight correlations of CD14++CD16- Mc levels with left ventricle (LV) end-systolic volume (r=0.28, p<0.05) and with LV ejection fraction (r=−0.23, p<0.1). According to the hospital follow-up, the 1st day count of CD14++CD16+ Mc was higher in patients with in-hospital complications (mean 42.9±6.9x106/L vs 26.6±5.3x106/L in uncomplicated cases, p<0.05), and was correlated with number of in-hospital complications per patient (r=0.25, p=0.05). Conclusion Higher baseline number of CD14++CD16+ Mc correlates with other “pro-inflammatory” indices (C-RP, ESR) and indicates the worse baseline cardio-hemodynamic and unfavorable course of in-hospital period in pts with STEMI, treated with PCI. Incremental in-hospital dynamic of all Mc populations was observed in multi-vessel lesion cases. Funding Acknowledgement Type of funding source: None