ACUTE CORONARY SYNDROMES

Association of haematological indices with the degree of microvascular injury in patients with acute anterior wall myocardial infarction treated with primary percutaneous coronary intervention

Murat Sezer, Irem Okcular, Taner Goren, Huseyin Oflaz, Ylmaz Nisanci, Berrin Umman, Fehmi Mercanoglu, Ahmet K Bilge, Mehmet Meric, Sabahattin Umman

Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

Correspondence to:
Dr M Sezer
Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; sezerm{at}istanbul.edu.tr; msezer{at}superonline.com

Background: In acute myocardial infarction (AMI), increased neutrophil count has been associated with more severe coronary artery disease and larger infarct size. Increased mean platelet volume (MPV) is also associated with poor clinical outcome and impaired angiographic reperfusion in patients with AMI. However, the associations of neutrophil count and MPV with the indices of tissue level reperfusion were not fully elucidated.

Aim: To elucidate the relationship between baseline neutrophil count and MPV on presentation and microvascular injury in patients with anterior AMI treated with primary percutaneous coronary intervention (pPCI).

Methods: 41 patients with anterior wall AMI treated successfully with pPCI were included. The leucocyte count, neutrophil count and MPV were obtained on admission, and the percentage of neutrophils was calculated. After PCI thrombolysis in myocardial infarction, grade 3 flow was established in all patients. The coronary flow velocity pattern (diastolic deceleration time (DDT)) was examined with transthoracic echocardiography and measured intracoronary pressures with fibreoptic pressure–temperature sensor-tipped guidewire in the left anterior descending artery within 48 h after pPCI. Thermodilution-derived coronary flow reserve (CFR) was calculated. Index of microvascular resistance (IMR) was defined as simultaneously measured distal coronary pressure divided by the inverse of the thermodilution-derived hyperaemic mean transit time. Subsequently, a short compliant balloon was placed in the stented segment and inflated to measure coronary wedge pressure (CWP).

Results: Higher neutrophil counts were strongly associated with higher IMR (r = 0.86, p<0.001), lower CFR (r = –0.60, p<0.001), shorter DDT (r = –0.73, p<0.001) and higher CWP (r = 0.73, p<0.001). Likewise, there were significant correlations among the percentage of neutrophils and CFR (r = –0.34, p = 0.02), IMR (r = 0.46, p = 0.002), DDT (r = –0.36, p = 0.01) and CWP (r = 0.49, p = 0.001). Relationships among leucocyte count and IMR (r = 0.38, p = 0.01), CFR (r = –0.33, p = 0.03), DDT (r = –0.36, p = 0.01) and CWP (r = 0.32, p = 0.026) were slightly significant. Higher neutrophil count remained independently associated with indices of microvascular perfusion in multivariable models controlling for age, smoking habits and time to treatment. Also, higher MPV on admission was strongly associated with higher IMR (r = 0.89, p<0.001), steeper DDT (r = –0.64, p<0.001), lower CFR (r = –0.43, p = 0.004) and higher CWP (r = 0.77, p<0.001).

Conclusion: Absolute and relative neutrophilia and higher MPV on admission were independently associated with impaired microvascular perfusion in patients with anterior AMI treated with pPCI. It is possible that neutrophilia and high MPV are simple surrogate markers of worse microvascular injury in patients with AMI.

Abbreviations: AMI, acute myocardial infarction; CFR, coronary flow reserve; CWP, coronary wedge pressure; DDT, diastolic deceleration time; IMR, index of microvascular resistance; LAD, left anterior descending artery; MPV, mean platelet volume; pPCI, primary percutaneous coronary intervention

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