Association of Monocyte Count on Admission with the Angiographic Thrombus Burden in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract Background: The intracoronary high-thrombus burden during the primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction (STEMI) can lead to poor outcomes. Monocytes have been described to play an important role in thrombotic disorders. Objectives: This study aimed to investigate the relationship between admission monocyte count and angiographic intracoronary thrombus burden in patients receiving primary percutaneous coronary intervention (PPCI). Methods: A total of 273 patients with acute STEMI who underwent PPCI were enrolled. The patients were divided into two groups according to the thrombolysis in myocardial infarction (TIMI) thrombus grade: low-thrombus burden group with a grade of 0-2 and high-thrombus burden group with a grade of 3-4. The monocyte count and other laboratory parameters were measured on admission before PPCI. P-value < 0.05 was considered significant. Results: There were 95 patients (34.8%) in the high-thrombus burden group, and 178 patients (65.2%) in the low-thrombus burden group. Patients with high-thrombus burden had significantly higher admission monocyte count (0.61 ± 0.29×109/L vs. 0.53 ± 0.24×109/L, p = 0.021). In multivariate analysis, monocyte count was the independent predictor of angiographic high-thrombus burden (odds ratio 3.107, 95% confidence interval [CI] 1.199-7.052, p = 0.020). For the prediction of angiographic high-thrombus burden, admission monocyte count at a cut-off value of 0.48×109/L yielded 0.59 ROC-AUC (71.9% sensitivity, 46.9% specificity). Conclusions: Monocyte count on admission was an independent clinical predictor of high-thrombus burden in patients with STEMI undergoing PPCI. Our findings suggest that admission monocyte count may be available for early risk stratification of high-thrombus burden in acute STEMI patients and might allow the optimization of antithrombotic therapy to improve the outcomes of PPCI.

研究背景：ST段抬高型心肌梗死（ST-elevation myocardial infarction, STEMI）患者接受直接经皮冠状动脉介入治疗（primary percutaneous coronary intervention, PPCI）时的冠状动脉内高血栓负荷可导致不良预后。单核细胞在血栓性疾病中发挥重要作用，已有相关研究报道。
研究目的：本研究旨在探讨接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者入院时单核细胞计数与冠状动脉造影示血栓负荷之间的关联。
方法：本研究共纳入273例接受直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者。根据心肌梗死溶栓治疗（thrombolysis in myocardial infarction, TIMI）血栓分级将患者分为两组：血栓负荷较低组（分级0~2级）与血栓负荷较高组（分级3~4级）。于直接经皮冠状动脉介入治疗前入院时检测单核细胞计数及其他实验室指标。以P值<0.05为差异具有统计学意义。
结果：血栓负荷较高组共95例患者（占比34.8%），血栓负荷较低组共178例患者（占比65.2%）。血栓负荷较高组患者的入院单核细胞计数显著更高（0.61±0.29×10^9/L vs 0.53±0.24×10^9/L，p=0.021）。多因素分析显示，单核细胞计数是冠状动脉造影示高血栓负荷的独立预测因素（优势比3.107，95%置信区间[CI] 1.199~7.052，p=0.020）。以0.48×10^9/L作为截断值预测冠状动脉造影示高血栓负荷时，受试者工作特征曲线下面积（Receiver Operating Characteristic Area Under the Curve, ROC-AUC）为0.59，灵敏度为71.9%，特异度为46.9%。
结论：入院时单核细胞计数可作为接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者高血栓负荷的独立临床预测因素。本研究结果提示，入院单核细胞计数可用于急性ST段抬高型心肌梗死患者高血栓负荷的早期风险分层，或可优化抗栓治疗方案以改善直接经皮冠状动脉介入治疗的临床结局。