Effect of Hematologic Parameters on Microvascular Reperfusion in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.

OBJECTIVES: Despite the significant role of certain hematologic parameters in reperfusion injury, their relationship with microvascular reperfusion remains not well understood. Therefore, our objective was to evaluate the relationship between hematologic parameters at admission and microvascular reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (primary PCI). METHODS: A total of 213patients (mean age: 57.5 ± 11 years) with STEMI were included. Blood samples were obtained from all patients prior to primary PCI. Electrocardiographic recordings were made for the evaluation of ST-segment resolution (STR) before and after primary PCI. Angiographic assessment in the infarct-related artery was performed using the myocardial blush grade (MBG) and thrombolysis in myocardial infarction (TIMI) flow. Patients were categorized into 2 groups as those with impaired microvascular reperfusion (STR <70%, TIMI: 0-1, and MBG: 0-1) and those with normal microvascular reperfusion (STR >70%, TIMI: 2-3, and MBG: 2-3). RESULTS: Of the overall study group, 139, 105, and 69 patients had an STR of <70%, MBG of 0-1, and TIMI of 0-1, respectively. Demographic parameters in both groups are shown in the tables. Patients with impaired microvascular reperfusion were found to have higher white blood cell (WBC) count, neutrophil count, lymphocyte count, and mean platelet volume (MPV). Neutrophil-lymphocyte ratio and platelet count were similar between the 2 groups. Correlation analysis showed a negative correlation between lymphocyte count and STR (r: -.195, P: .004), lymphocyte count and TIMI flow(r: -.09, P: .14), and lymphocyte count and MBG (r: -.211, P: .002). CONCLUSION: Our results suggest that higher WBC count and MPV at admission are independent predictors of impaired microvascular perfusion in patients with STEMI. On the other hand, a negative correlation was found between lymphocyte count and impaired microvascular perfusion. Specifically, elevated lymphocyte count seemed to indicate the presence of impaired microvascular reperfusion in patients with STEMI.

Predischarge ST segment and T wave patterns in predicting left ventricular function and myocardial viability in Q wave anterior myocardial infarction patients.

The aim of this study was to investigate the correlation between ECG changes prior to discharge and findings of early low dose dobutamine stress echocardiography (LDSE) performed in 6 +/- 2 days, in patients experiencing their first acute anterior MI. A total of 62 patients admitted with their first acute anterior MI were divided into three groups according to the findings of electrocardiograms performed on the 7-10th days: group A, isoelectric ST and negative or positive T wave; group B, ST elevation (> 0.1 mV) and negative T wave; and group C, ST elevation and positive T wave. There were no significant differences between the groups with respect to thrombolytic therapy and reperfusion criteria. In addition, 90% of the patients in group A (20/22), 66% in group B (12/18, P < 0.05 versus group A), and only 54% in group C (12/22, P < 0.01 versus group A) responded to LDSE. The infarct zone wall motion score index (WMSI) measured by LDSE was significantly decreased in group A compared to basal values (from 2.71 +/- 0.65 to 2.07 +/- 0.71 P = 0.02), and it was significantly different compared to groups B and C. Moreover, the serum creatinine kinase level of the patients in group C was higher (P < 0.01 versus group A), whereas the ejection fraction was inferior (group A 48%, group B 47%, and group C 41%, P = 0.04 versus group A). When the correlations between good left ventricular function and terminal QRS distortion, sum ST elevation, the number of leads with ST elevation, ST elevation shape on admission, and ST and T alterations in ECG at discharge were investigated, an independent correlation was found between ST and T alteration in ECG and a WMSI value < 2 at rest or after LDSE (P = 0.03, OR 3.08, 95%CI 1.05-8.98). At the infarct zone of patients with ST elevation and positive T waves, left ventricular function is worse and the viability is less. This simple classification may be useful in predicting left ventricular function at the time of discharge.

The relationship between terminal QRS complex distortion and early low dose dobutamine stress echocardiography in acute anterior myocardial infarction.

Although the damage in myocardial infarction has been demonstrated to be related with the magnitude and number of ST elevation, its relation with terminal distortion of QRS is unclear. The relationship between terminal QRS distortion in ECGs on admission and the results of early low dose dobutamine stress echocardiography (LDSE) performed 6 +/- 2 days later was investigated. Patients admitted to our clinic within the first six hours of their chest pain and without a prior infarction diagnosis were divided into two groups based on the admission electrocardiogram as the absence (QRS-, n = 33) or presence (QRS+, n = 29) of distortion of the terminal portion of the QRS in > or = 2 leads (QRS+; J point at > 50% of the R wave amplitude in lateral leads or presence of ST elevation without S wave in leads V1-V3). There were no significant differences between the groups with respect to thrombolytic therapy or reperfusion criteria. During LDSE, the infarct zone wall motion score index (WMSI) in the QRS- group was significantly decreased relative to baseline (from 2.93 +/- 0.65 to 2.37 +/- 0.84, P = 0.02), and it was significantly different compared with WMSI in the QRS+ group (P = 0.005). Improvement of akinetic regions to hypokinetic regions in the infarct zone (IZ) was found to be 33.5% (44/131) in the QRS- group and 17.8% (27/151 P = 0.004) in the QRS+ group. Furthermore, 55.1% (10/29) of the patients in the QRS+ group and only 18.1% (6/33) of those in the QRS- group did not respond to LDSE (P < 0.05). In multiple logistic regression analysis, while there was no relationship between good left ventricular functions (WMSI < 2) and terminal QRS distortion under basal conditions (P = 0.07), an independent relation was observed to exist between them after LDSE (P = 0.03, OR 4.48, 95% CI, 1.13-17.7). Moreover, plasma CK levels were higher in the QRS+ group (P = 0.03), whereas the ejection fraction was worse (P = 0.01). In both groups, there was no correlation between the Selvester score and left ventricle WMSI at baseline, but this correlation was significantly improved with LDSE (QRS-; r = 0.39 P = 0.02 and QRS+; r = 0.44 P = 0.01) The viability in the IZ is relatively less in those patients with terminal QRS distortion observed in their ECG on admission. This simple classification would be useful in predicting left ventricular function at the time of discharge.

The relationship of ST segment elevation shape with preserved myocardium and signal-averaged electrocardiography in acute anterior myocardial infarction.

Although a relation between magnitude of ST segment elevation and myocardial damage has been shown in the early period of acute myocardial infarction (AMI), such a relation between the shape of the ST segment elevation, myocardial damage, and the clinical course remains obscure. For this purpose 62 first anterior AMI patients admitted in the first 6h were enrolled for the study. On the basis of precordial V3 derivation prior to thrombolytic therapy, the shape of the ST elevation was separated into three groups: concave (n = 26), straight (n = 24), or convex types (n = 12). The relation between the shape of the ST elevation recorded on admission, and the results of pre-discharge low-dose dobutamine stress echocardiography (LDE) performed (n = 53) and signal-averaged ECG values were investigated. The basal wall motion score index (WMSI) and response to LDE in the concave group were better in the infarct zone. Additionally, the average akinetic segment number in the infarct zone was higher, and improvement in these segments was less in the convex and straight groups (concave 3.78 +/- 2 vs 2.17 +/- 2.1, P < 0.01; straight 5.15 +/- 2.7 vs 4.45 +/- 2.8, not significant (NS); convex 5.4 +/- 2.3 vs 4.8 +/- 2.1, NS; basal vs LDE). While only 13% (3/23) of the patients did not respond to LDE (P < 0.05 vs group B and P < 0.01 vs group C), 35% (7/20) of group B and 60% (6/10) of group C patients did not respond to LDE. Although no relation was found between better left ventricular function (WMSI < 2) and shape of the ST elevation in basal evaluation by multiple logistic regression analysis (P = 0.06), an independent relation was found between them following LDE (P = 0.01, odds ratio (OR) 4.5, 95% Confidence Interval (CI) 1.3-14.7). The incidence of ventricular late potential (LP) positivity was 11% (3/26) in the concave group, 16% (4/24) in the straight group, and 58% (7/12) in the convex group (P < 0.001 vs concave and P < 0.05 vs straight groups). We found that shape of the ST elevation could significantly predict the presence of late potentials in multiple logistic regression analysis (P = 0.003, OR 10.7, 95% CI 2.2-51.7). There was no in-hospital death in the concave group, whereas five patients died in either the straight or the convex group. Furthermore, arrhythmia was lower in the concave group during this period (P < 0.05), and exercise capacity was lower. In conclusion, we determined that there was a higher viable myocardium, and lower LP(positivity) and in-hospital mortality in patients with concave ST elevation on admission.