Increased Platelet-leukocyte Aggregates Are Associated With Myocardial No-reflow in Patients With ST Elevation Myocardial Infarction

Am J Med Sci. 2016 Sep;352(3):261-6. doi: 10.1016/j.amjms.2016.05.034. Epub 2016 Jun 9.

Abstract

Objective: We aimed to investigate the association between platelet-leukocyte aggregates (PLA) levels on admission and the risk of myocardial no-reflow in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).

Methods: A total of 83 patients with STEMI undergoing primary PCI were included in the current study. Platelet-leukocyte conjugates (PLA), including platelet-monocyte aggregates (PMA), platelet-neutrophil aggregates (PNA) and platelet-lymphocyte aggregates were studied by flow cytometry in peripheral venous blood. No-reflow was defined as coronary blood flow grade thrombolysis in myocardial infarction ≤2 or thrombolysis in myocardial infarction 3 and myocardial blush grade ≤2.

Results: No-reflow was observed in 19 patients (22.9%). Compared with the reflow group, the level of PNA (76.5 ± 13.3) and PMA (90.3 ± 5.2) before PCI no-reflow group was significantly higher than that in normal reflow (P < 0.001). Using multiple logistic regression analysis, PNA (odds ratio [OR] = 1.179; 95% CI: 1.035-1.342; P = 0.013) and PMA (OR = 1.248; 95% CI: 1.040-1.498; P = 0.017) were found to be a significant predictor of no-reflow together with pain to balloon time (OR = 1.022; 95% CI: 1.002-1.041; P = 0.028), estimated glomerular filtration rate (OR = 1.311; 95% CI: 1.009-1.856; P = 0.047) and higher thrombus burden (OR = 0.061; 95% CI: 0.006-0.658; P = 0.021). Receiver operating characteristic curve analysis revealed that PNA (area under the curve = 0.881; 95% CI: 0.809-0.952; P < 0.001), PMA (area under the curve = 0.794; 95% CI: 0.699-0.889; P < 0.001) have important predictive value for the myocardial no-reflow.

Conclusions: Our study indicated that preprocedural increased PLA levels display a significantly independent association with no-reflow phenomenon after PCI. Increased PLA levels may predict the development of no-reflow phenomenon in patients with STEMI who underwent PCI.

Keywords: Acute myocardial infarction; Inflammation reaction; No-reflow; Platelet-leukocyte aggregates; Thrombosis.

MeSH terms

  • Aspirin / administration & dosage
  • Aspirin / therapeutic use
  • Blood Platelets / metabolism
  • Blood Platelets / pathology*
  • Clopidogrel
  • Coronary Angiography
  • Coronary Circulation*
  • Coronary Thrombosis / blood
  • Coronary Thrombosis / prevention & control
  • Electrocardiography
  • Female
  • Flow Cytometry
  • Humans
  • Leukocytes / metabolism
  • Leukocytes / pathology*
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / immunology
  • Myocardial Infarction / surgery
  • No-Reflow Phenomenon / blood*
  • No-Reflow Phenomenon / epidemiology
  • No-Reflow Phenomenon / immunology
  • Percutaneous Coronary Intervention*
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / therapeutic use
  • Predictive Value of Tests
  • Retrospective Studies
  • Ticlopidine / administration & dosage
  • Ticlopidine / analogs & derivatives
  • Ticlopidine / therapeutic use

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin