Journal Article Ahead of print
PubMed: 42235147 DOI: 10.1016/j.jacbts.2026.101563
Prolonged Inflammation Associates With Greater Infarct Size and Poor Outcome After ST-Segment Elevation Myocardial Infarction.
JACC Basic Transl Sci 11(7):101563
Authors: Christian Graesser, Johannes Krefting, Marius Schwab, Hendrik Scheidhauer, Sophie Novacek, Nicolás López Armbruster, Julia Hinterdobler, Svenja Rapelius, Amos Romer, Philipp M Rumpf, Ferdinand Roski, Tobias Lenz, Felix Voll, Baiba Vilne, Teresa Trenkwalder, Moritz von Scheidt, Erion Xhepa, Michael Joner, Salvatore Cassese, Sabine Steffens, Christian Weber, Heribert Schunkert, Gjin Ndrepepa, Adnan Kastrati, Thorsten Kessler, Aldo Moggio, Hendrik B Sager
Affiliations
- German Heart Centre Munich, Department of Cardiology, TUM University Hospital, Technical University of Munich, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany; Department of Internal Medicine III - Cardiology and Angiology, Saarland University Medical Center, Homburg/Saar, Germany.
- German Heart Centre Munich, Department of Cardiology, TUM University Hospital, Technical University of Munich, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
- German Heart Centre Munich, Department of Cardiology, TUM University Hospital, Technical University of Munich, Munich, Germany.
- Bioinformatics Group, Rīga Stradiņš University, Rīga, Latvia.
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany; Institute for Cardiovascular Prevention, Ludwig Maximilians University Munich, Munich, Germany; Institute for Diabetes and Cancer, Helmholtz Zentrum Munich, Neuherberg, Germany.
- German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany; Institute for Cardiovascular Prevention, Ludwig Maximilians University Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
- German Heart Centre Munich, Department of Cardiology, TUM University Hospital, Technical University of Munich, Munich, Germany; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
Abstract
AIMS
Acute myocardial infarction (MI) induces a systemic inflammatory response that usually resolves within days, but the prognostic impact of persistent inflammation is uncertain. We assessed whether sustained leukocytosis after ST-segment elevation myocardial infarction (STEMI) relates to infarct size, left ventricular function, and clinical outcomes.
METHODS AND RESULTS
In >1,700 STEMI patients treated with primary percutaneous coronary intervention, leukocytes peaked on admission and typically normalized by day 3. Patients were stratified by leukocyte tertiles at admission and day 3. High day 3 leukocyte counts were associated with larger infarct size (scintigraphy; peak creatine kinase-myocardial band and troponin T), worse left ventricular function in hospital and at 6 months, and higher 1- and 5-year mortality. Patients whose leukocyte counts declined had better recovery, whereas persistent leukocytosis marked the poorest outcomes. Monocyte RNA sequencing showed post-MI transcriptomic reprogramming, and murine MI models recapitulated a similar systemic immune response.
CONCLUSIONS
Persistent inflammation, particularly elevated leukocyte counts at day 3 post-MI, is associated with adverse remodeling and increased mortality after STEMI, identifying unresolved inflammation as a negative prognostic marker and potential therapeutic target.
MeSH
Mortality, Ventricular Function, Left, Myocardial Infarction, St Elevation Myocardial Infarction, Leukocytes, Ventricular Function, Leukocytosis, Leukocyte Count