Association between baseline neutrophil count, clopidogrel therapy, and clinical and angiographic outcomes in patients with ST-elevation myocardial infarction receiving fibrinolytic therapy.

Abstract

AIMS:

To investigate the association between neutrophil count, outcomes, and benefit of clopidogrel therapy in ST-elevation myocardial infarction (STEMI).

METHODS AND RESULTS:

Baseline neutrophil count was measured in 2865 patients in CLARITY-TIMI 28, a randomized trial of clopidogrel vs. placebo in STEMI patients undergoing fibrinolysis. Angiography was performed at 2-8 days following enrollment. Analyses were adjusted for demographics, time from symptom onset, Killip class, peak CK-MB, and therapies received. A baseline neutrophil count in the highest quartile was independently associated with the risk of cardiovascular (CV) death [adj (adjusted) OR (odds ratio) 5.8, P < 0.001] and congestive heart failure (adj OR 3.0, P = 0.009) at 30 days. Patients with higher neutrophil counts were less likely to achieve complete ST-segment resolution (adj OR 0.76, P = 0.03) or TIMI myocardial perfusion grade 2/3 (adj OR 0.71, P = 0.017). Clopidogrel had a lesser effect on reducing the odds of a closed infarct-related artery, or death or MI before angiography, in patients with a neutrophil count above the median (adjusted OR 0.83, 0.61-1.13) vs. in those below the median (adjusted OR 0.46, 0.33-0.64) (Pinteraction = 0.008).

CONCLUSION:

In patients with STEMI, higher baseline neutrophil count is associated with worse angiographic findings and increased CV mortality, as well as a diminished benefit of clopidogrel.

• Authors: Michelle O'Donoghue, David A Morrow, Christopher P Cannon, Wei Guo, Sabina A Murphy, C Michael Gibson, Marc S Sabatine
• Journal: European heart journal (Eur Heart J) Vol. 29 Issue 8 Pg. 984-91 (Apr 2008) ISSN: 0195-668X [Print] England
• PMID: 18346960 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine

Topics

• Clopidogrel
• Coronary Angiography
• Epidemiologic Methods
• Female
• Humans
• Leukocyte Count
• Male
• Middle Aged
• Myocardial Infarction (diagnostic imaging, drug therapy, mortality)
• Neutrophils
• Platelet Aggregation Inhibitors (therapeutic use)
• Thrombolytic Therapy (methods)
• Ticlopidine (analogs & derivatives, therapeutic use)
• Treatment Outcome