Author/Authors :
Palmerini، نويسنده , , Tullio and Brener، نويسنده , , Sorin J. and Genereux، نويسنده , , Philippe and Maehara، نويسنده , , Akiko and Della Riva، نويسنده , , Diego and Mariani، نويسنده , , Andrea and Witzenbichler، نويسنده , , Bernhard and Godlewski، نويسنده , , Jacek and Parise، نويسنده , , Helen and Dambrink، نويسنده , , Jan-Henk E. and Ochala، نويسنده , , Andrzej and Fahy، نويسنده , , Martin and Xu، نويسنده , , Ke and Gibson، نويسنده , , C. Michael and Stone، نويسنده , , Gregg W.، نويسنده ,
Abstract :
Although it has been shown that elevated white blood cell count (WBCc) on presentation is associated with an increased risk of cardiac mortality in patients with ST-segment elevation myocardial infarction (STEMI), the responsible mechanisms are unknown. We therefore sought to investigate whether elevated WBCc is associated with increased infarct size measured with cardiac magnetic resonance imaging 30 days after primary percutaneous coronary intervention in the Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction trial. INFUSE AMI randomized patients with STEMI and proximal or mid–left anterior descending coronary artery occlusion to bolus intracoronary abciximab versus no abciximab and to manual aspiration versus no aspiration. WBCc at hospital admission was available in 407 of 452 randomized patients. Patients were stratified according to tertiles of WBCc. At 30 days, a significant stepwise increase in infarct size (percentage of total left ventricular mass) was apparent across tertiles of increasing WBCc (median [interquartile range] for tertiles I vs II vs III = 11.2% [3.8% to 19.6%] vs 17.5% [0.5% to 22.9%] vs 19.1% [13.7 to 26.0], respectively, p <0.0001). Absolute infarct mass in grams and abnormal wall motion score were also significantly increased across tertiles of WBC. By multivariate linear regression analysis, WBCc was an independent predictor of infarct size along with intracoronary abciximab randomization, age, time from symptom onset to first device, proximal left anterior descending location, and baseline TIMI flow of 0/1. In conclusion, in patients with anterior wall STEMI, an elevated admission WBCc is a powerful independent predictor of infarct size measured with cardiac magnetic resonance imaging 30 days after primary percutaneous coronary intervention.
