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• W2028005992 abstract "La obstrucción microvascular tras un infarto agudo de miocardio con elevación del segmento ST se asocia a mal pronóstico. La fisiopatología de este fenómeno no está totalmente definida. Analizamos las implicaciones de la linfopenia post-reperfusión en la existencia de obstrucción microvascular. Estudiamos prospectivamente a 212 pacientes que habían sufrido un primer infarto agudo de miocardio con elevación del segmento ST reperfundido con agentes trombolíticos o con angioplastia primaria y con la arteria responsable abierta. Cuantificamos de manera seriada las cifras de linfocitos, neutrófilos y monocitos. Usamos la resonancia magnética cardiaca para determinar la existencia de obstrucción microvascular en la primera semana post-infarto. Se repitió el estudio a los 6 meses del infarto. Detectamos obstrucción microvascular en 67 (32%) pacientes. Observamos que una cifra de linfocitos post-reperfusión < 1.800 células/ml se asociaba a un riesgo alto de obstrucción microvascular (el 44 frente al 20%; p < 0,001), así como menor fracción de eyección y volúmenes de ventrículo izquierdo mayores (p < 0,05). En el estudio multivariado ajustado por las características basales, electrocardiograma, marcadores de necrosis y variables angiográficas, una cifra de linfocitos post-reperfusión < 1.800 células/ml incrementó de manera independiente el riesgo de obstrucción microvascular (odds ratio = 3,2 [1,6-6,3]; p < 0,001). En el infarto de miocardio con elevación del segmento ST, la linfopenia post-reperfusión es un predictor precoz y potente de la existencia de obstrucción microvascular. Las posibles implicaciones fisiopatológicas y terapéuticas de esta asociación requieren más estudios. The presence of microvascular obstruction after ST-segment elevation acute myocardial infarction is associated with a poor outcome. The pathophysiology of this process has not been fully defined. The aim of this study was to investigate the relationship between post-reperfusion lymphopenia and microvascular obstruction. This prospective study involved 212 patients with a first ST-segment elevation acute myocardial infarction who underwent reperfusion with thrombolytic agents or primary angioplasty and who had an open infarct-related artery. Serial measurements of lymphocyte, neutrophil and monocyte counts were taken. Cardiac magnetic resonance was used to detect microvascular obstruction during the first week after the infarction. Imaging was repeated 6 months after infarction. Microvascular obstruction was observed in 67 patients (32%). A post-reperfusion lymphocyte count <1800 cells/ml was associated with a higher risk of microvascular obstruction (44% versus 20%; P<.001) as well as with a low left ventricular ejection fraction and large left ventricular volumes (P<.05). After adjustment for baseline characteristics, ECG findings, necrosis marker levels and angiographic variables, multivariate analysis showed that a post-reperfusion lymphocyte count <1800 cells/ml was independently associated with an increased risk of microvascular obstruction (odds ratio=3.2; 95% confidence interval 1.6-6.3; P<.001). In ST-segment elevation myocardial infarction, post-reperfusion lymphopenia is an early and powerful predictor of the presence of microvascular obstruction. The pathophysiological and therapeutic implications of this association require further study." @default.
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• W2028005992 date "2009-10-01" @default.
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• W2028005992 title "Linfopenia post-reperfusión y obstrucción microvascular en el infarto agudo de miocardio con elevación del segmento ST" @default.
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