基础白细胞计数增高的急性心肌梗死患者冠状动脉介入术后冠状动脉血流储备降低对远期预后的影响

The correlation between coronary flow reserve and clinical outcomes in patients with primary angioplasty for acute myocardial infarction with high baseline white blood cell count

目的急性心肌梗死(AMI)患者在接受了冠状动脉介入术(PCI)后,即刻冠状动脉血流储备(CFR)的降低,以及AMI急性期基础血液中白细胞计数的增加均被视为AMI患者远期预后不良的预测因子。我们现将这两项指标联合起来评价AMI患者的远期预后。方法选自2010年8月至2012年6月在医院就诊的AMI患者共72例,所有患者在发病24 h内接受了急诊PCI治疗,并于术后即刻应用经冠状动脉多普勒导丝测量的CFR。基础血白细胞计数以患者发病24 h内化验取得,并满足白细胞计数≥10.0×109/L。所有患者均进行了临床随访,平均随访时间(12.7±7.1)个月,以观察主要不良心脏事件(MACE)。根据MACE与CFR的关系,应用ROC曲线获得相关阈值,将患者分为2组进行对照分析,第一组:CFR<1.4;第二组:CFR≥1.4。结果第一组患者的基础血CK及CK-MB明显高于第二组患者,分别为(4 109±407)U/L vs.(2 685±562)U/L,P<0.05及(290.8±26.6)ng/ml vs.(255.7±65.6)ng/ml,P<0.05。第一组患者PCI术后即刻MBG3级占比明显低于第二组患者(25.9%vs.38.9%,P<0.05)。随访期间第一组患者的MACE明显高于第二组(40.7%vs.27.8%,P<0.05),主要体现在总死亡率的增高上(13.0%vs.0,P<0.05)。结论对于基础血白细胞计数增高的AMI患者,接受急诊PCI治疗后CFR<1.4是预示患者远期预后不良的重要因素,这部分患者的总死亡率明显高于CRF≥1.4的患者。这一结果进一步阐明了微血管功能及炎症反应与AMI患者的远期预后的关系。

Objective Both abnormal coronary flow reserve （CFR） following percutaneous coronary intervention （PCI） and elevated white blood cell （WBC） count in acute myocardial infarction （AMI） are known as useful predictors for adverse outcomes. We evaluated the value of abnormal CFR for prediction of adverse outcomes in AMI patients with high baseline WBC count following primary PCI. Methods We studied 72 consecutive patients （mean age 56±12, male 55） presenting with AMI who were admitted to our institution. Analyze of CFR was performed following PCI by intra-coronary Doppler wire. All enroll patents’ baseline WBC count was obtained at admission and WBC count≥10.4×109/L. The occurrence of major adverse cardiac events （MACE） were analyzed during clinical follow up （12.7±7.1 months）. According to the best cutoff value of CFR for predicting MACE, the patients were divided into 2 groups：group 1 with CFR〈1.4, group 2 with CFR≥1.4. Results Baseline CK and CK-MB in group 1 were significantly higher than in group 2[（4 109±407）U/L vs. （2 685±562）U/L, P〈0.05; （290.8±26.6）ng/ml vs. （255.7±65.6）ng/ml, P〈0.05 respectively]; Percent of post PCI MBG grade3 were more often in group 2 than in group 1（25.9%vs. 38.9%, P〈0.05）. MACE rate were significantly higher in group 1 than in group 2（40.7%vs. 27.8%, P〈0.05）, the mortality rate was significantly higher in group 1 than in group 2（13.0% vs. 0, P〈0.05）. Conclusions Abnormal CFR following PCI with high baseline WBC count in patients with AMI were associated with a higher incidence of adverse long-term clinical outcomes. This observation may provide a potential explanation that links of microvascular dysfunction and vascular inflammation in patients with AMI.