Relation Between White Blood Cell Counts and Myocardial Reperfusion in Patients With Recanalized Anterior Acute Myocardial Infarction

Abstract

he white blood cell (WBC) count on admission is a strong and independent predictor of increased morbidity and mortality in patients with acute myocardial infarction (AMI), 1-3 although the mechanism underlying these observations is unclear. Recent studies have reported that an elevated WBC count on admission is associated with a larger infarct size, 2,4 but whether it is the cause or the result of the large infarct remains to be determined. The development of ischemic myocardial damage may time-dependently elevate the WBC count in patients with AMI, 4 suggesting that the WBC count during the acute phase of AMI may be affected by the duration of the ischemia. Previous studies have assessed the relation between the WBC count and infarct size, without examining ischemic time, so the present study sought to clarify the relation of the WBC count on admission to infarct size and myocardial reperfusion according to ischemic time in patients with a recanalized anterior AMI. Methods Study GroupThe study group comprised 135 consecutive patients (mean age 59±11 years; 111 men, 24 women) with an AMI who fulfilled the following criteria: (1) no history of myocardial infarction; (2) complete occlusion (TIMI grade 0 flow) 5 of the left anterior descending (LAD) coronary artery on admission with achievement of TIMI grade 3 flow as confirmed by coronary angiography within 6 h of symptom onset; (3) electrocardiograms (ECGs) obtained before and after recanalization; (4) adequate assessment of myocardial blush grade after recanalization; (5) a patent LAD coronary artery as confirmed by predischarge coronary angiography, performed a mean of 14 days after AMI; and (6) no concomitant noncardiac diseases, such as inflammatory disorders, malignancy, or infection. The diagnosis of anterior AMI was based on typical chest pain lasting more than 30 min, ST-segment elevation of at least 2 mm in at least 2 contiguous precordial leads, and a subsequent increase in the serum creatine kinase (CK) concentration to more than twice the upper limit of normal. Coronary AngiographyCoronary angiography was performed immediately after admission. The grade of collateral filling in the LAD coronary artery was evaluated as described by Rentrop et al. 6 A good collateral channel was defined as grade 2 or 3, and a poor collateral channel as grade 0 or 1. The allocation of recanalization therapy was left to the attending doctor's discretion. 7,8 Recanalization was defined as the establishment of TIMI grade 3 flow. In the right coronary artery and the left circumflex coronary artery, stenosis was considered clinically significant if the lumen diameter was narrowed by 75% or more in any projection. Myocardial blush was Background The clinical significance of the white blood cell (WBC) count on admission in relation to the duration of ischemia in acute myocardial infarction (AMI) remains unclear. Methods and ResultsThe relationship of the WBC count on admission to myocardial reperfusion was examined in 135 patients with recanalization of an anterior AMI within 6...

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