Association between inflammatory mediators and angiographic morphologic features indicating thrombus formation in patients with acute myocardial infarction

( views:, downloads: )
LI Dong-bao(Department of Cardiology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
HUA Qi(Department of Cardiology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
LIU Zhi(Department of Cardiology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
LI Jing(Department of Cardiology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
XU Li-qing(Department of Cardiology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
WANG Shan(Department of Cardiology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
JIN Wei-ying(Department of Cardiology,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
Journal Title:
Volume 122, Issue 15, 2009
Key Word:
acute myocardial infarction;thrombosis;neutrophil;percutaneous coronary intervention;C-reactive protein

Abstract: Background Inflammatory mechanisms had played an important role in the occurrence and prognosis of acute myocardial infarction,inflammatory mediators was associated with adverse outcomes of acute myocardial infarction.This study tested the hypothesis that in the acute phase of myocardial infarction with ST-segment elevation,neutrophil count and high-sensitivity C-reactive protein are predictive of angiographic morphologic features that indicate thrombus formation in the infarct-related artery.Methods This retrospective study included 182 consecutive patients with acute myocardial infarction and ST-segment elevation.Patients were assigned to a thrombus-formation group(n=77)and a non-thrombus-formation group(n=106).All patients had a Killip's classification≤3 and onset<12 hours prior to presentation.All the cases were going to undergo coronary angiography,including primary percutaneous coronary intervention,simple coronary angiography,or thrombolysis in a coronary artery(or arteries)or coronary artery bypass graft(s).Blood samples for measurement of high-sensitivity C-reactive protein and for routine blood laboratory studies were collected prior to coronary angiography.Results The levels of high-sensitivity C-reactive protein,total leukocyte counts,neutrophil counts,and neutrophil/lymphocyte ratios were substantially higher in the thrombus-formation group than in the non-thrombus-formation group patients(for each,P<0.05).Stepwise Logistic regression analyses identified high-sensitivity C-reactive protein,neutrophil count,and neutrophil/lymphocyte ratio as independent predictors of thrombus formation in the infarct-related artery(for each,P<0.05).Conclusions In patients with acute myocardial infarction,higher neutrophil counts,neutrophil/lymphocyte ratio,and levels of high-sensitivity C-reactive protein are predictors to indicate thrombus formation.

  • [1]Barron HV,Hart SD,Radfort MJ,Wang Y,Krumholz HM.The association between white blood cell count and acute myocardial infarction mortality in patients>or =65 years of age:findings from the cooperative cardiovascular project.J Am Coil Cardiol 2001;38:1654-1661.
  • [2]Cusack MR,Marber MS,Lambiase PD,Bucknall CA,Redwood SR.Systemic inflammation in unstable angina is the result of myocardial necrosis.J Am Coil Cardioi 2002;39:1917-1923.
  • [3]Youssef AA,Chang LT,Sheu JJ,Lee FY,Chua S,Yeh KH,et al.Association between circulating level of CD40 ligand and angiographic morphologic features indicating high-burden thrombus formation in patients with acute myocardial infarction undergoing primary coronary.Circ J 2007;71:1857-1861.
  • [4]Verma S,Li SH,Badiwala MV,Weisel RD,Fedak PW,Li RK,et al.Endothelin antagonism and interleukin-6 inhibition attenuate the proatherogenic effects of C-reactive protein.Circulation 2002;105:1890-1896.
  • [5]Ridker PM.High-sensitivity C-reactive protein:potential adjunct for global risk assessment in primary prevention of cardiovascular disease.Circulation 2001;103:1813-1818.
  • [6]Barron HV,Cannon CE Murphy SA,Braunwald E,Gibson CM.Association between white blood cell count,epicardial blood flow,myocardial perfusion,and clinical outcomes in the setting of acute myocardial infarction:a thrombolysis in myocardial infarction 10 substudy.Circulation 2000;102:2329-2334.
  • [7]Home BD,Anderson JL,John JM,Weaver A,Bait TL,Jensen KR,et al.Which white blood cells subtypes predict increased cardiovascular risk? J Am Coil Cardiol 2005;45:1638-1643.
  • [8]Duffy BK,Gurm HS,Rajagopal V,Gupta R,Ellis SG,Bhatt DL.Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long term mortality after percutaneous coronary intervention.Am J Cardiol 2006;97:993-996.
  • [9]Burke AP,Tracy RP,Kologie F,Malcom GT,Zieske A,Butys R,et al.Elevated C-reactive protein values and athcrosclerosis in sudden coronary death:association with different pathologies.Circulation 2002;105:2019-2023.
  • [10]Yip HK,Chen MC,Chang HW,Hang CL,Hsieh YK,Fang CY,et al.Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction:predictors of slow flow and no-reflow.Chest 2002;122:1322-1332.
  • [11]Tanaka A,Kawarabayashi T,Nishibori Y,Sano T,Nishida Y,Fukuda D,et al.No-reflow phenomenon and lesion morphology in patients with acute myocardial infarction.Circulation 2002;105:2148-2152.
  • [12]Yip HK,Wu C.J,Chang HW,Chen MC,Hang CL,Fang CY,et al.Comparison of impact of primary percutaneous transluminal coronary angioplasty and primary stenting on short-term mortality in patients with cardiogenic shock and evaluation of prognostic determinants.Am J Cardiol 2001;87:1184-1188.
  • [13]Hoshiba Y,Hatakeyama K,Tanabe T,Asada Y,Goto S.Co-localization of yon Willebrand factor with platelet thrombi,tissue factor and platelets with fibrin,and consistent presence of inflammatory cells in coronary thrombi obtained by an aspiration device from patients with acute myocardial infarction.J Thromb Haemost 2006;4:114-120.
  • [14]Menon V,Lessard D,Yarzbski J,Furman MI,Gore JM,Goldberg RJ.Leukocytosis and adverse hospital outcomes after acute myocardial infarction.Am J Cardiol 2003;92:368-372.
  • [15]Sweetnam p.Thomas H,Yamell J,Baker I,Elwood E Total and differential leukocyte counts as predictors of ischemic heart disease:the Caerphilly and Speedwell studies.Am J Epidemiol 1997;145:416-421.
  • [16]Huang ZC,Chien KL,Yang CY,Wang CH,Chang T,Chen CJ.Peripheral differential leukocyte counts and subsequent mortality for all diseases,cancers,and cardiovascular diseases in Taiwanese.J Formos Med Assoc 2003;102:775-781.
  • [17]Kawaguchi H,Mori T,Kawano T,Kono S,Sasaki J,Arakawa K.Band neutrophil count and the presence and severity of coronary atherosclerosis.Am Heart J 1996;132(1 Pt 1):9-12.
  • [18]Naruko T,Ueda M,Haze K,van der Wal AC,van der Loos CM,ltoh A,et al.Neutrophil infiltration of culprit lesions in acute coronary syndromes.Circulation 2002;106:2894-2900.
  • [19]Palabrica T,Lobb R,Furie BC,Aronovitz M,Benjamin C,Hsu YM,et al.Leukocyte accumulation promoting fibrin deposition is mediated in vivo by p-selectin on adherent platelets.Nature 1992;359:848-851.
  • [20]Zazula AD,Précoma-Neto D,Gomes AM,Kruklis H,Barbieri GF,Forte RY,et al.An assessment of neutrophiis/lymphocytes ratio in patients suspected of acute coronary syndrome.Arq Bras Cardiol 2008;90:30-35.
  • [21]Shah PK.Circulating markers of inflammation for vascular risk prediction:are they ready for prime time? Circulation 2000;101:1758-1759.
  • [22]Mueller C,Buetmer H J,Hodgson JM,Marsch S,Perruchoud AP,Roskamm H,et al.Inflammation and long-term mortality after non-ST elevation acute coronary syndrome treated with a very early invasive strategy in 1042 consecutive patients.Circulation 2002;105:1412-1415.
  • [23]Ridker PM,Rifai N,Rose L,Buring JE,Cook NR.Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events.N Engl J Med 2002;347:1557-1565.
  • [24]Lindahl B,Toss H,Siegbahn A,Venge P,Wallentin L.Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease.N Engl J Med 2000;343:1139-1147.
  • [25]Kaul U,Singh B,Sudan D,Sapra R,Yadav RD,Ghose T,et al.Primary stenting in acute myocardial infarction:a 30-day follow up study.Catheter Cardiovasc Interv 1999;46:4-10.
  • [26]Kern M J,Moore JA,Aguirre FV,Bach RG,Garacciolo EA,Wolford T,et al.Determination of angiographic(TIMI grade)blood flow by intracoronary doppler flow velocity during acute myocardial infarction.Circulation 1996;94:1545-1552.
  • [27]Zhang XW,Ge JB,Yang JM,Ge L,Wang NF,Gao Y,et al.Relationship between hs-CRP,proMMP-1,TIMP-1 and coronary plaque morphology:intravascular ultrasound study.Chin Med J 2006;119:1689-1694.
  • [28]Fu XH,Fan WZ,Gu XS,Wei YY,Jiang YF,Wu WL,et al.Effect of intracoronary administration of anisodamine on slow reflow phenomenon following primary percutaneous coronary intervention in patients with acute myocardial infarction.Chin Med J 2007;120:1226-1231.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615