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Inflammatory cell response following ST-elevation myocardial infarction treated with primary percutaneous coronary intervention and its impact on cardiovascular outcomes: A systematic review and meta-analysis. Int J Cardiol 2023; 376:1-10. [PMID: 36758862 DOI: 10.1016/j.ijcard.2023.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Inflammatory responses post STEMI may mediate major adverse cardiovascular events (MACE). This is the first systematic review to map leukocyte response following a STEMI and its association with outcomes. METHODS We systematically searched EMBASE and Medline for studies of STEMIs undergoing primary PCI. Eligible studies reported leukocytes or its subtype plus either 30-day and/or 1-year MACE. Random effects model for pooled proportions was used to estimate 30-day and 1-year mortality and MACE. Meta-regression was used to estimate the effect of leukocyte counts on cardiovascular outcomes. Publication bias was assessed using Egger's regression-based test. The review was registered with PROSPERO (CRD42019124991). RESULTS Of the 3,813 studies meeting the preliminary search criteria, 24 cohort studies were eligible for inclusion, representing 19,074 persons [76.4% male (n = 14,539); mean age 61.6 years]. Leukocytes had a mean of 10.5x109 (SD 4.7) on admission and 11.1x109 (SD 3.3) at day one post STEMI. Neutrophils increased day one post STEMI, while lymphocytes decreased. There was limited data on other leukocyte subtypes and beyond day one. Estimated 30-day and 1-year all-cause mortality were 6.5% (95% CI 4.8-8.2, p <0.001) and 9.7% (95% CI 5.6-13.8, p <0.001), while the estimated 30-day and 1-year MACE were 14.9% (95% CI 5.3-24.4, p < 0.001) and 15.2% (95% CI 7.2-23.2, p < 0.001). The meta-analysis was limited by a high degree of heterogeneity between studies. CONCLUSIONS This review highlights the urgent need to better characterise inflammation post STEMI to identify mediators for the persistently high mortality and morbidity associated with STEMI.
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Liu CW, Ke SR, Tseng GS, Wu YW, Hwang JJ. Elevated serum uric acid is associated with incident hypertension in the health according to various contemporary blood pressure guidelines. Nutr Metab Cardiovasc Dis 2021; 31:1209-1218. [PMID: 33618920 DOI: 10.1016/j.numecd.2021.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 11/01/2020] [Accepted: 01/02/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Elevated serum uric acid (SUA) is associated with hypertension according to its traditional definition. We investigated the association between SUA and incident hypertension according to the European Society of Cardiology (ESC) and American Society of Cardiology (ACC) guidelines. METHODS AND RESULTS In this retrospective cohort study, we enrolled 10,537 healthy individuals ≥30 years old who underwent a routine annual health examination with office blood pressure recorded at our hospital in 2016; of the participants, 7349 repeated the exam in 2017. According to the ESC and ACC guidelines, hypertension was defined as office BP ≥ 140/90 mmHg or ≥130/80 mmHg. Hyperuricemia (HUA) was defined as SUA ≥7 mg/dL in men and ≥6 mg/dL in women. The hypertension incidence was 5.8% among 6378 individuals in the ESC cohort and 19% among 4330 individuals in the ACC cohort. Incident hypertension was significantly more common in the hyperuricemic group than in the normouricemic group (ESC: 8.6% vs. 4.7%, P < 0.001; ACC: 25.5% vs. 16.9%, P < 0.001). In the fully adjusted multivariate logistic regression analyses, each increase in SUA was associated with an increase in incident hypertension risk (ESC: adjusted OR: 1.167, 95% CI: 1.061-1.284, P = 0.001; ACC: adjusted OR: 1.125, 95% CI: 1.044-1.213, P = 0.002). The association can be explained by a significant correlation of baseline SUA with the BP in the following year (r = 0.24, P < 0.001 for baseline SUA and SBP in the following year; r = 0.239, P < 0.001 for baseline SUA and DBP in the following year). CONCLUSION Elevated SUA was associated with incident hypertension in healthy individuals according to various contemporary BP guidelines (ClinicalTrials.gov: NCT03473951). CLINICAL TRIALS ClinicalTrials.gov with the identification number of NCT03473951.
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Affiliation(s)
- Cheng-Wei Liu
- Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan; Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shin-Rong Ke
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Guo-Shiang Tseng
- Department of Internal Medicine, Division of Cardiology, Taoyuan Armed Forces General Hospital, Taoyuan County, Taiwan
| | - Yen-Wen Wu
- Department of Internal Medicine and Nuclear Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Nuclear Medicine and Cardiology, Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Juey-Jen Hwang
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
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Wang Y, Xu R, Yin X, Wang J, Feng L, Zhou J. Comparison of the predictive value of four-dimensional speckle tracking imaging risk classification and the TIMI system after STEMI reperfusion therapy. Exp Ther Med 2018; 16:4129-4135. [PMID: 30402155 PMCID: PMC6200968 DOI: 10.3892/etm.2018.6666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/07/2018] [Indexed: 11/06/2022] Open
Abstract
The predictive value of four-dimensional speckle tracking imaging (4D-STI) risk classification and TIMI risk scores for the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion therapy were investigated. One hundred and twenty patients with STEMI after reperfusion therapy were involved. At 12 h after reperfusion therapy, 2nd and 3rd day, the three-dimensional longitudinal strain (LS), circumferential strain (CS) and radial strain (RS), area strain (AS), as well as other 4D-STI detection indicators, were collected. The patients were followed up for one year, and were divided into good prognosis group and poor prognosis group. LS, CS, RS and AS indicators were analyzed between these two groups. The ROC curve was drawn to establish the 4D-STI risk classification and its predictive value for poor prognosis and mortality were compared with TIMI risk scores. AS, LS and RS at 12 h after reperfusion treatment, and AS and RS at 2nd and 3rd day had a certain degree of prediction accuracy in STEMI patients in the poor prognosis group. In the 4D-STI and TIMI risk scores, the risk of death and adverse prognosis significantly increased as the risk scores increased (P<0.01). The 4D-STI risk score for predicting poor prognosis and mortality was greater than the TIMI risk score. 4D-STI risk scores are superior to TIMI risk scores in predicting poor prognosis and mortality in patients with STEMI after reperfusion therapy.
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Affiliation(s)
- Yingchun Wang
- Department of Ultrasound, Shanghai Jiading Center Hospital, Shanghai 201800, P.R. China
| | - Rong Xu
- Department of Ultrasound, Shanghai Jiading Center Hospital, Shanghai 201800, P.R. China
| | - Xiaohua Yin
- Department of Radiology, Shanghai Jiading Center Hospital, Shanghai 201800, P.R. China
| | - Jing Wang
- Department of Ultrasound, Shanghai Jiading Center Hospital, Shanghai 201800, P.R. China
| | - Lan Feng
- Department of Ultrasound, Shanghai Jiading Center Hospital, Shanghai 201800, P.R. China
| | - Jie Zhou
- Department of Ultrasound, Shanghai Jiading Center Hospital, Shanghai 201800, P.R. China
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Liu CW, Wu YW. Heart Rate Behind Systemic Inflammatory Response Syndrome Associated with One-Year Mortality in the Patients with Acute Myocardial Infarction? ACTA CARDIOLOGICA SINICA 2018; 34:291. [PMID: 29844652 DOI: 10.6515/acs.201805_34(3).20180331a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Cheng-Wei Liu
- Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei.,Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
| | - Yen-Wen Wu
- Departments of Internal Medicine.,Departments of Nuclear Medicine, National Taiwan University College of Medicine and Hospital, Taipei.,Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City.,National Yang-Ming University School of Medicine, Taipei, Taiwan
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Liang Y, Chen H, Wang P. Correlation of Leukocyte and Coronary Lesion Severity of Acute Myocardial Infarction. Angiology 2017; 69:591-599. [PMID: 29130316 DOI: 10.1177/0003319717740782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leukocytes play a pivotal role in the onset and progression of acute myocardial infarction (AMI). We evaluated the relationship between leukocyte count and coronary lesion severity of AMI. We carried out a retrospective study involving 815 patients with AMI undergoing primary percutaneous coronary intervention from 2005 to 2014 at a cardiovascular center. We recorded their risk factors, routine blood parameters, and cardiovascular events during hospitalization. When thrombus and nonthrombus burden groups were compared, leukocyte count (9.55 [7.80, 12.29] vs 10.70 [8.67, 13.04]×109/L, P = .005), neutrophil count (7.48 [5.65, 10.18] vs 8.61 [6.61, 10.80]×109/L, P = .001), and neutrophil–lymphocyte ratio (NLR; 4.99 [2.97, 7.16] vs 10.70 [8.67, 13.04], P = .003) were significantly different. Patients in the total occlusion group showed higher leukocyte count, neutrophil count, and NLR compared to the nontotal occlusion group. After multivariate logistic analysis, a neutrophil count ≥8.355 × 109/L was independently associated with high thrombus burden and total coronary occlusion. Leukocyte count, neutrophil count, or NLR was not significantly related to cardiovascular events during hospitalization. In conclusion, the neutrophil count might be an independent predictor of high thrombus burden and total coronary occlusion.
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Affiliation(s)
- Yunting Liang
- Department of Pediatric Cardiovascular Center, Anzhen Hospital, Beijing, China
- Yunting Liang and Hui Chen are the co-first authors
| | - Hui Chen
- Department of Cardiovascular Center, Friendship Hospital, Beijing, China
- Yunting Liang and Hui Chen are the co-first authors
| | - Ping Wang
- Department of Cardiovascular Center, Friendship Hospital, Beijing, China
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Mahmood E, Knio ZO, Mahmood F, Amir R, Shahul S, Mahmood B, Baribeau Y, Mueller A, Matyal R. Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients. PLoS One 2017; 12:e0182118. [PMID: 28873411 PMCID: PMC5584953 DOI: 10.1371/journal.pone.0182118] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 07/12/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC) count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients. METHODS Cardiac surgeries were extracted from the 2007-2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality. RESULTS Out of a total of 10,979 cardiac surgery patients 863 (7.8%) had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09-1.36, p = 0.002) with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications. CONCLUSION Preoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications.
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Affiliation(s)
- Eitezaz Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ziyad O. Knio
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rabia Amir
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sajid Shahul
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bilal Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Albany Medical College, Albany, New York, United States of America
| | - Yanick Baribeau
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Keskin M, Hayıroğlu MI, Keskin T, Kaya A, Tatlısu MA, Altay S, Uzun AO, Börklü EB, Güvenç TS, Avcı II, Kozan Ö. A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index. Nutr Metab Cardiovasc Dis 2017; 27:438-446. [PMID: 28392077 DOI: 10.1016/j.numecd.2017.01.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM The prognostic impact of poor nutritional status and cardiac cachexia in myocardial infarction is not clearly understood. Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in colorectal surgeries and postoperative septic complications. The present study aimed to evaluate the prognostic value of PNI in ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND RESULTS We evaluated the in-hospital and long-term (3 years) prognostic impact of PNI on 1823 patients with STEMI undergoing primary percutaneous coronary intervention. Patients with lower PNI had significantly higher in-hospital and long-term mortality and major adverse cardiac events. After adjustment for all confounders, the in-hospital mortality rates were 7.9 times higher at the lower PNI level (95% CI: 5.0-15.8) than those at the higher PNI level. The long-term mortality rates were also 6.4 times higher at the lower PNI level (95% CI: 4.4-12.4) than those at the higher PNI level. CONCLUSION The present study demonstrated that the PNI, calculated based on the serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients with STEMI.
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Affiliation(s)
- M Keskin
- Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - M I Hayıroğlu
- Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - T Keskin
- Yeshiva University, Albert Einstein College of Medicine and Montefiore Medical Center, Department of Allergy/Immunology, Bronx, NY, USA
| | - A Kaya
- Duzce University, Department of Cardiology, Duzce, Turkey
| | - M A Tatlısu
- Texas A&M University, Department of Cardiology, TX, USA
| | - Servet Altay
- Trakya University, Department of Cardiology, Edirne, Turkey
| | - A O Uzun
- Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - E B Börklü
- Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - T S Güvenç
- Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - I I Avcı
- Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ö Kozan
- Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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