ABC | Volume 110, Nº4, April 2018

Original Article Wang et al Monocyte count and thrombus burden Arq Bras Cardiol. 2018; 110(4):333-338 1. Taleb S. Inflammation in atherosclerosis. Arch Cardiovasc Dis. 2016;109(12):708-15. doi: 10.1016/j.acvd.2016.04.002. 2. Dutta P, Nahrendorf M. Monocytes in myocardial infarction. Arterioscler Thromb Vasc Biol. 2015;35(5):1066-70. doi: 10.1161/ ATVBAHA.114.304652. 3. Wang Z, Ren L, Liu N, Lei L, Ye H, Peng J. Association of monocyte count on admissionwith angiographic no-reflowafter primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Kardiol Pol. 2016;74(10):1160-1166. doi: 10.5603/KP.a2016.0065. 4. Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP, et al. Combination therapywith abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation. 2001;103(21):2550-4. doi: https://doi.org/10.1161/01.CIR.103.21.2550. 5. Sianos G, Papafaklis MI, Serruys PW. Angiographic thrombus burden classification in patients with ST-segment elevation myocardial infarction treated with percutaneous coronary intervention. J Invasive Cardiol. 2010;22(10 Suppl B):6B-14B. 6. Higuma T, Soeda T, Yamada M, Yokota T, Yokoyama H, Izumiyama K, et al. Does residual thrombus after aspiration thrombectomy affect the outcome of primary PCI in patients with ST-segment elevation myocardial infarction?:Anopticalcoherencetomographystudy. JACCCardiovasc Interv. 2016;9(19):2002-11. doi: 10.1016/j.jcin.2016.06.050. 7. Piccolo R, Galasso G, Iversen AZ, Eitel I, Dominguez-Rodriguez A, Gu YL, et al.Effects of baseline coronary occlusion and diabetes mellitus in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol. 2014;114(8):1145-50. doi: 10.1016/j.amjcard.2014.07.030 8. Lee WC, Chen HC, Fang HY, Hsueh SK, Chen CJ, Yang CH, et al. Comparisonofdifferentstrategies foracuteST-segmentelevationmyocardial infarction with high thrombus burden in clinical practice: Symptom-free outcome at one year. Heart Lung. 2015;44(6):487-93. doi: 10.1016/j. hrtlng.2015.08.003. 9. Teng N, Maghzal GJ, Talib J, Rashid I, Lau AK, Stocker R. The roles of myeloperoxidase in coronary artery disease and its potential implication in plaque rupture. Redox Rep. 2017;22(2):51-73. doi: 10.1080/13510002.2016.1256119. 10. Chistiakov DA, Orekhov AN, Bobryshev YV. Contribution of neovascularization and intraplaque haemorrhage to atherosclerotic plaque progression and instability. Acta Physiol (Oxf). 2015;213(3):539-53. doi: 10.1111/apha.12438. 11. Cimmino G, Loffredo FS, Morello A, D’Elia S, De Palma R, Cirillo P, et al. Immune-inflammatory activation in acute coronary syndromes: a look into the heart of unstable coronary plaque. Curr Cardiol Rev. 2017;13(2):1-8. doi: 10.2174/1573403X12666161014093812. 12. Hisada Y, Alexander W, Kasthuri R, Voorhees P, Mobarrez F, Taylor A, et al. Measurement of microparticle tissue factor activity in clinical samples: A summary of two tissue factor-dependent FXa generation assays. Thromb Res. 2016 Mar;139:90-7. doi: 10.1016/j.thromres.2016.01.011. References vivo-obtained thrombus specimens of STEMI patients revealed that approximately 50% of the aspirated thrombi were days to even weeks old, 18 which suggests that prothrombotic factors, such as elevated levels of circulating monocyte, may starts days or even weeks before symptom onset during STEMI. In the current study, admission monocyte count was evaluated regarding its potency to differ between high thrombus burden and low thrombus burden in STEMI patients underwent PPCI. However, admission monocyte count at cut-off value of 0.48×10 9 /L presented a low diagnostic performance with 71.9% sensitivity and 46.9% specificity. A combination of parameters, including monocyte count, may be needed to improve diagnostic abilities. The main limitations of this study were the retrospective design and relatively small number of patients. Also, the prior antithrombotic therapeutic profiles of the study population, which might affect intracoronary thrombotic status during PPCI, were not routinely available in the present study and not included in the risk factor analysis. Further large prospective cohort study with assessment of detailed information of prior antithrombotic therapy might be more illuminating. Conclusions In conclusion, we found that monocyte count on admission, which is cheaply and easily measurable laboratory data, is a predictor of high intracoronary thrombus burden in patients with STEMI undergoing primary PCI. Author contributions Conception and design of the research and Critical revision of the manuscript for intellectual content: Wang Z, Peng J; Acquisition of data and Analysis and interpretation of the data: Wang Z, Liu N, Ren L, Lei L, Ye H; Statistical analysis and Writing of the manuscript: Wang Z. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Beijing Shijitan Hospital, Capital Medical University under the protocol number L08-002. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 337