Eosinopenia as an adverse marker of clinical outcomes in patients presenting with acute myocardial infarction.
Am J Med. 2019 May 29;:
Authors: Alkhalil M, Kearney A, Hegarty M, Stewart C, Devlin P, Owens CG, Spence MS
BACKGROUND: Eosinopenia is considered a surrogate of inflammation in several disease settings. Following ST- segment elevation myocardial infarction, eosinopenia is presumed to be a marker of infarct severity. We sought to study the relationship between eosinopenia and infarct severity and how this relationship determined the long-term outcomes following ST-segment elevation myocardial infarction.
METHODS: 606 consecutive ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention from a large volume single centre were enrolled. Low eosinophil count was defined as <40 cells/ml from samples within 2-h post reperfusion. Primary endpoint was defined as composite of death, myocardial infarction, stroke, unplanned revascularisation, re-admission for heart failure over 3.5years follow up.
RESULTS: 65% of patients had eosinopenia. Patients in the low eosinophil group had larger infarct size as measured by troponin value [2934 vs. 1177ng/L, P<0.001] and left ventricle systolic function on echocardiography [48% vs. 50%, P=0.029]. There was a weak correlation between eosinophil count and both troponin (r=-0.25, P<0.001) and ejection fraction (r=0.10, P=0.017). The primary endpoint was higher in eosinopenic patients (28.8% vs. 20.4%; HR 1.49, 95%CI 1.05 to 2.13, P=0.023). A discordance between eosinopenia and severe left ventricle systolic dysfunction was observed in 55.6% of cases. Compared with normal count, eosinopenia was associated with worse clinical outcomes in patients with non-severe left ventricle dysfunction (24.1% vs. 16.2%; HR 1.58, 95%CI 1.01 to 2.45, P=0.044) but not in those with severe left ventricle dysfunction (42.3% vs. 38.9%; HR 1.10, 95%CI 0.59 to 2.03, P=0.77) (P<0.01 for interaction).
CONCLUSIONS: Eosinopenia is an easily-determined marker that reflects worse clinical outcomes over long term follow up.
PMID: 31152721 [PubMed - as supplied by publisher]