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

• Published in: The American journal of the medical sciences 2016-09, Vol.352 (3), p.261-266
• Main Authors: Ren, Faxin, Mu, Nan, Zhang, Xia, Tan, Jinxi, Li, Liudong, Zhang, Chuanhuan, Dong, Mei
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Aspirin - administration & dosage; Aspirin - therapeutic use; Blood Platelets - metabolism; Blood Platelets - pathology; Coronary Angiography; Coronary Circulation; Coronary Thrombosis - blood; Coronary Thrombosis - prevention & control; Electrocardiography; Female; Flow Cytometry; Humans; Inflammation reaction; Leukocytes - metabolism; Leukocytes - pathology; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - epidemiology; Myocardial Infarction - immunology; Myocardial Infarction - surgery; No-reflow; 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; Platelet-leukocyte aggregates; Predictive Value of Tests; Retrospective Studies; Thrombosis; Ticlopidine - administration & dosage; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1016/j.amjms.2016.05.034

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). 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. 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. 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.