RESUMEN
Red cell distribution width (RDW) is an indirect marker of inflammation and an independent predictor of long-term mortality. The aim of this study was to determine RDW values in patients with ST-elevation acute myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) and evaluate its association with adverse outcomes. We measured RDW in STEMI patients before undergoing primary PCI and divided into low and high RDW. Patients were followed up to 3 years after their discharge for the occurrence of in-hospital, 30-days, and long-term major adverse cardiovascular events (MACEs) and mortality. We included 485 patients with a mean age of 61.1(±12.5) years, 62.9% were male. In multivariate analysis, RDW remained independent predictor of long-term mortality and MACE [relative risk (RR) 1.51; 95% confidence interval (95% CI) = 1.11-2.05; P = 0.007 and RR = 1.42; 95% CI = 1.30-1.82; P = 0.004. Area under the curve for long-term mortality was 0.65 (95% CI = 0.61-0.69; P < 0.0001). RDW < 13.4 had a negative predictive value of 87.4% for all-cause mortality. Patients who had worse outcomes remained with higher values of RDW during the follow-up. In conclusion, high RDW is an independent predictor of long-term mortality and MACE in patients with STEMI undergoing primary PCI. A low RDW has an excellent negative predictive value for long-term mortality. Patients with sustained elevated levels of RDW have worse outcomes at long-term follow-up.
Asunto(s)
Índices de Eritrocitos , Mortalidad , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST/cirugía , Lesión Renal Aguda/epidemiología , Anciano , Área Bajo la Curva , Causas de Muerte , Estudios de Cohortes , Stents Liberadores de Fármacos , Femenino , Mortalidad Hospitalaria , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Complicaciones Posoperatorias/epidemiología , Pronóstico , Estudios Prospectivos , Infarto del Miocardio con Elevación del ST/sangre , Stents , Accidente Cerebrovascular/epidemiología , Trombosis/epidemiologíaRESUMEN
BACKGROUND AND AIMS: Elevated neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) are indirect inflammatory markers. There is some evidence that both are associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). The aim of the present study was to compare the capacity of NLR and MPV to predict adverse events after primary PCI. METHODS: In a prospective cohort study, 625 consecutive patients with STEMI, who underwent primary PCI, were followed. Receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) for the occurrence of procedural complications, mortality and major adverse cardiovascular events (MACE). RESULTS: Mean age was 60.7 (±12.1) years, 67.5% were male. The median of NLR was 6.17 (3.8-9.4) and MPV was 10.7 (10.0-11.3). In multivariate analysis, both NLR and MPV remained independent predictors of no-reflow (relative risk [RR]â¯=â¯2.26; 95%confidence interval [95%CI]â¯=â¯1.16-4.32; pâ¯=â¯0.01 and RRâ¯=â¯2.68; 95%CIâ¯=â¯1.40-5.10; pâ¯<â¯0.01, respectively), but only NLR remained an independent predictor of in-hospital MACE (RRâ¯=â¯1.01; 95%CIâ¯=â¯1.00-1.06; pâ¯=â¯0.02). The AUC for in-hospital MACE was 0.57 for NLR (95%CIâ¯=â¯0.53-0.60; pâ¯=â¯0.03) and 0.56 for MPV (95%CIâ¯=â¯0.52-0.60; pâ¯=â¯0.07). However, when AUC were compared with DeLong test, there was no statistically significant difference for these outcomes (pâ¯>â¯0.05). NLR had an excellent negative predictive value (NPV) of 96.7 for no-reflow and 89.0 for in-hospital MACE. CONCLUSIONS: Despite no difference in the ROC curve comparison with MPV, only NLR remained an independent predictor for in-hospital MACE. A low NLR has an excellent NPV for no-reflow and in-hospital MACE, and this could be of clinical relevance in the management of low-risk patients.
Asunto(s)
Plaquetas , Linfocitos , Neutrófilos , Intervención Coronaria Percutánea/efectos adversos , Infarto del Miocardio con Elevación del ST/terapia , Anciano , Femenino , Humanos , Recuento de Linfocitos , Masculino , Volúmen Plaquetario Medio , Persona de Mediana Edad , Intervención Coronaria Percutánea/mortalidad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Medición de Riesgo , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/sangre , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Background: Although new studies and guidelines can be considered useful tools, it does not necessarily mean they are put into clinical practice. Objective: The aim of the current analysis was to assess the changes in primary percutaneous coronary intervention (PCI) and mortality in a tertiary university hospital in southern Brazil during a six-year period .Methods: We have included consecutive patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI between March 2011 and February 2017. Previous clinical history, characteristics of the procedure, and reperfusion strategies were collected. In-hospital, short and long-term mortalities were also evaluated. The significance level adopted for all tests was 5%. Results: There was an increase in the use of radial access in patients from 20.0% in 2011 to 62.7% in 2016 (ptrend < 0.0001). Moreover, thrombus aspiration decreased significantly from 66.7% in 2011 to less than 3.0% in 2016 (ptrend < 0.0001). In-hospital, short and long-term mortalities remained reasonably stable from 2011 to 2016 (ptrend > 0.05). However, a lower in-hospital mortality was observed in patients treated through radial access (p < 0.001). Cardiogenic shock occurred in 11.1%, without statistical differences in the period (ptrend = 0.39), while long-term mortality rate decreased from 80.0% in 2011 to 27.3% in 2016 in this patient group (ptrend = 0.29). Conclusions: During a 6-year follow-up period, primary PCI characteristics underwent important modifications. Radial access became widely used, with a decrease in mortality with the use of this route, while aspiration thrombectomy became a rare procedure. The incidence of cardiogenic shock remained stable, but has shown a reduction in its mortality