Korean Circ J.  2011 Feb;41(2):68-75. 10.4070/kcj.2011.41.2.68.

Effect of Aspiration Thrombectomy on Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction With an Elevated Neutrophil Count

• Lee HY
• Kim JH
• Kim BO
• Kang YJ
• Ahn HS
• Hwang MW
• Park KM
• Byun YS
• Goh CW
• Rhee KJ

• KMID: 2225138
• DOI: http://doi.org/10.4070/kcj.2011.41.2.68

Abstract

BACKGROUND AND OBJECTIVES
Aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI) is an effective adjunctive therapy for ST-segment elevation myocardial infarction (STEMI). An elevated neutrophil count in STEMI is associated with microvascular dysfunction and adverse outcomes. We evaluated whether AT can improve microvascular dysfunction in patients with STEMI and an elevated neutrophil count.
SUBJECTS AND METHODS
Seventy patients with STEMI undergoing primary PCI from August 2007 to February 2009 in our institution were classified by tertiles of neutrophil count on admission (<5,300/mm3, 5,300-7,600/mm3, and >7,600/mm3). The angiographic outcome was post-procedural thrombolysis in myocardial infarction (TIMI) flow grade. Microvascular dysfunction was assessed by TIMI myocardial perfusion (TMP) grade and ST-segment resolution on electrocardiography 90 minutes after PCI. The clinical outcome was major adverse cardiac event (MACE), defined as cardiac death, re-infarction, and target lesion revascularization at 9 months.
RESULTS
There were no significant differences in the clinical characteristics and pre- and post-procedural TIMI flow grades between the neutrophil tertiles. As the neutrophil count increased, a lower tendency toward TMP grade 3 (83% vs. 52% vs. 54%, p=0.06) and more persistent residual ST-segment elevation (>4 mm: 13% vs. 26% vs. 58%, p=0.005) was observed. The 9-month MACE rate was similar between the groups. On subgroup analysis of AT patients (n=52) classified by neutrophil tertiles, the same tendency toward less frequent TMP grade 3 (77% vs. 56% vs. 47%, p=0.06) and persistent residual ST-segment elevation (>4 mm: 12% vs. 28% vs. 53%, p=0.05) was observed as neutrophil count increased.
CONCLUSION
A higher neutrophil count at presentation in STEMI is associated with more severe microvascular dysfunction after primary PCI, which is not improved with AT.

Keyword

Myocardial infarction; Neutrophils

MeSH Terms

Death
Electrocardiography
Humans
Myocardial Infarction
Neutrophils
Percutaneous Coronary Intervention
Perfusion
Thrombectomy
Thymidine Monophosphate
Thymidine Monophosphate

Figure

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  Fig. 1 TMP grades, ST-segment resolution, and residual ST-segment elevation in all patients. A: TMP grade. B: ST-segment resolution. C: residual ST-segment elevation. TMP: thrombolysis in myocardial infarction myocardial perfusion.

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  Fig. 2 TMP grades, ST-segment resolution, and residual ST-segment elevation in patients undergoing aspiration thrombectomy. A: TMP grade. B: ST-segment resolution. C: residual ST-segment elevation. TMP: thrombolysis in myocardial infarction myocardial perfusion.

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