| Zheng Zhen Guo, Myeong-Ho Yoon, Li Dong Hao, Seung-Jae Tahk, So-Yeon Choi, Byoung-Joo Choi, Seong-ill Woo, Jung-Won Hwang, Hong-Seok, Lim, Joon-Han Shin. |
BACKGROUND: Not only the elevated white blood cell (WBC) count and high sensitive C reactive protein (hs-CRP), but also the abnormal post procedure coronary flow reserve (CFR) in acute myocardial infarction (AMI) are known as useful predictors for clinical outcomes. This study was designed to evaluate relationship between WBC count, hs-CRP, abnormal CFR, and its prediction of adverse outcomes in AMI patients following percutaneous coronary intervention (PCI). METHODS: Total 87 AMI patients (mean age 55±13, male 72) were enrolled in this study from 2004 to 2005. Whatever the patient received thrombolytic therapy or not, all patients received PCI therapy, post-PCI CFR was measured by intracoronary Doppler guidewire. Peak hs-CRP and peak WBC count without evidence of infection during hospitalization was collected in this study. According to the major adverse cardiac events (MACE) during follow up, best cutoff value of hs-CRP and WBC count were analyzed by ROC curve, and the patients were divided into 3 groups: group 1, WBC count>10.23×109or hs-CRP>0.8; group 2, both WBC count>10.23×109 and hs-CRP>0.8; group 3, both WBC count≤10.23×109 and hs-CRP≤0.8. Clinical follow up were performed in all patients (21±7 months). The MACE included death, non fatal MI, congestive heart failure, coronary artery bypass graft and target vessel revascularization. RESULTS: WBC count was significant correlated with hs-CRP (r=0.341, p=0.001). Both elevated WBC count and hs-CRP were correlated with decreased post-procedure CFR (r=-0.320, p=0.003; r=-0.251, p=0.020, respectively) and increased hyperemic microvascular resistance index (r=0.241, p=0.043; r=-0.260, p=0.029, respectively). Group 3 had Significant higher post-PCI CFR than in group 1 and group 2 (2.51±0.80 vs. 1.94±0.71, p=0.005; 2.51±0.80 vs. 1.49±0.38, p<0.001). MACE and mortality rate during follow up were significant higher in group 2 than in the other 2 groups (MACE rate: 27.5%, 50.0%, 5.0%, respectively, p=0.009; mortality rate: 0, 25.0%, 0, respectively, p<0.001). CONCLUSION: Elevated WBC count and hs-CRP in patients with AMI mainly associated with damaged CFR, which can be used as a strong predictor of adverse long term outcomes in these patients.
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