Predictive value of postprocedural leukocyte count on myocardial perfusion, left ventricular function and clinical outcomes in ST-elevated myocardial infarction after percutaneous coronary intervention

作     者：HE Rong LI Hai-yan GUO Li-jun ZHANG Fu-chun NIU Jie ZHANG Yong-zhen WANG Gui-song YANG Zhen-hua GAO Wei 

作者机构：Department of CardiologyPeking University Third HospitalKey Laboratory of Cardiovascular Molecular Biology and Regulatory PeptidesMinistry of HealthKey Laboratory of Molecular Cardiovascular SciencesMinistry of EducationBeijing 100191China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2012年第125卷第6期

页      面：1023-1029页

核心收录：

学科分类：1008[医学-中药学(可授医学、理学学位)] 1002[医学-临床医学] 08[工学] 09[农学] 0901[农学-作物学] 0836[工学-生物工程] 090102[农学-作物遗传育种] 10[医学] 

主　　题：angioplasty, transluminal, percutaneous coronary leukocyte myocardial infarction left ventricular dysfunction prognosis 

摘      要：Background Baseline white blood cell （WBC） count was correlated with ischemic events occurrence in patients with ST-elevated myocardial infarction （STEMI）. However, circulating WBC count is altered after percutaneous coronary intervention （PCI）. The aim of this study was to assess the relationship between postprocedural WBC count and clinical outcomes in STEMI patients who underwent PCI. Methods A total of 242 consecutive acute STEMI patients who underwent successful primary PCI were enrolled and followed up for two years. WBC counts were measured within 12 hours after PCI. ST-segment resolution （ST-R） and myocardial blush grades （MBG） were evaluated immediately after PCI. Left ventricular ejection fraction （LVEF） was obtained at baseline and 12-18 months after PCI. Results Postprocedural WBC count was an independent inverse predictor of ST-R （OR 0.80, P 〈0.0001） and MBG 3 （OR 0.82, P 〈0.0001）. It was negatively correlated with LVEF （baseline r=0.22, P=0.001; 12-18 months r=0.29, P 〈0.0001）. The best cutoff value of WBC for predicting death was determined to be 13.0×10^9/L. The patients with a postprocedural WBC count above 13.0×10^9/L showed a significantly lower cumulative survival rate （30 days, 82.4% vs. 99.0%, P 〈0.0001 and 2 years 75.0% vs. 96.4%, P 〈0.0001）. Multivariate Cox regression analysis showed that a postprocedural WBC count was a strong independent predictor of 30-day mortality （HR 8.48, P=0.019） and 2-year mortality （HR 4.93, P=0.009）. Conclusions Increased postprocedural WBC count is correlated with myocardial malperfusion and left ventricular dysfunction, and is an independent predictor of poor clinical outcomes in STEMI patients who underwent PCI.