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CLINICAL STUDY: MYOCARDIAL INFARCTION

Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction:a possible role for left ventricular remodeling

^* Cardiopulmonary Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

Manuscript received June 5, 2001; revised manuscript received September 6, 2001, accepted October 23, 2001.

^* Reprint requests and correspondence: Dr. Toshihisa Anzai, Cardiopulmonary Division, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
anzai{at}cpnet.med.keio.ac.jp

OBJECTIVES: The aim of this study was to determine the significance of peripheral monocytosis in clinical outcome after reperfused acute myocardial infarction (AMI), especially relating to post-infarct left ventricular (LV) remodeling.

BACKGROUND: Peripheral monocytosis occurs two to three days after AMI, reflecting infiltration of monocytes and macrophages into the necrotic myocardium. However, the prognostic significance of peripheral monocytosis after AMI remains to be determined.

METHODS: A total of 149 patients with first Q-wave AMI were studied. White blood cell (WBC) count, percentage of monocytes and serum C-reactive protein level were measured every 24 h for four days after the onset of AMI. We assessed association between peripheral monocytosis and prognosis including pump failure, LV aneurysm and long-term outcome after AMI.

RESULTS: Patients with pump failure (p < 0.0001) or LV aneurysm (p = 0.005) had higher peak monocyte counts than those without these complications. Predischarge left ventriculography revealed that peak monocyte count was positively correlated with LV end-diastolic volume (p = 0.024) and negatively correlated with ejection fraction (p = 0.023). Multivariate analyses showed that peak monocyte count 900/mm³ was an independent determinant of pump failure (relative risk [RR] 9.83, p < 0.0001), LV aneurysm (RR 4.78, p = 0.046) and cardiac events (RR 6.30, p < 0.0001), including readmission for heart failure, recurrent myocardial infarction and cardiac deaths, including sudden deaths.

CONCLUSIONS: Peripheral monocytosis is associated with LV dysfunction and LV aneurysm, suggesting a possible role of monocytes in the development of LV remodeling after reperfused AMI.

Abbreviations and Acronyms   ACE   angiotensin-converting enzyme   AMI   acute myocardial infarction   BNP   brain natriuretic peptide   CI   confidence interval   CK   creatine kinase   CRP   C-reactive protein   IL-6   interleukin-6   LV   left ventricular   MCP-1   monocyte chemoattractant protein-1   M-CSF   macrophage-colony stimulating factor   PTCA   percutaneous transluminal coronary angioplasty   RR   relative risk   WBC   white blood cell

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