| Objective: Enhanced inflammatory response is an important pathophysiological basis for postinfarction remodeling and heart failure.Monocytes are an essential component of innate immunity and are implicated in many inflammatory diseases.Human monocyte could be differentiated into three subpopulations: “classical” CD14++CD16–(Mon1),“intermediate”CD14++CD16+(Mon2),and “nonclassical” CD14+CD16++ monocytes(Mon3).In recent years,a serial of studies highlight the critical role of circulating monocyte subsets contributes to impaired myocardial healing and to atherosclerotic plaque destabilization.But the prognostic role of monocyte subsets in patients suffering from ST-segment elevation acute myocardial infraction(STEMI)is still unclear.In the present study,we aimed to investigate the following unresolved issues in STEMI,1)The predictive value of circulating monocyte subsets in patients suffering from STEMI and predictive long-term major adverse cardiac events(MACE).2)The addtive value of circulating monocyte subsets and traditional cardiovascular risk factors perdiction model on prediction of MACE in patients with STEMI.Methods: Patients who admitted within 24 hours after the onset of STEMI undergoing PCI treatment to the Pingjin Hospital Heart Center were enrolled.Blood routine test,platelet aggregation and coagulation function and other plasma markers were obtained in each patient.Flow cytometry(FCM)was used to analyze the subsets of monocyte separately.Transthoracic Doppler echocardiography was used to evaluate LV function on 24 hours after symptom attack.The major adverse cardiac events(MACE)in 3 years were recorded.Which was defined as cardiovascular death,nonfatal ischemic stroke,recurrent MI,need for emergency or repeat revascularization,and rehospitalization for heart failure.All deaths were considered cardiovascular deaths if noncardiovascular death could be excluded.Multivariate Logistic regression model was applied to establish the traditional cardiovascular risk stratification model for MACE of STEMI.ROC(receiver operating characteristic curve)area under the curve(AUC),Net reclassification improvement(NRI)and integrated discrimination improvement(IDI)for multiple logistic regression analyses was used to assess the risk stratification model.Results: During a median follow-up of three years of 221 eligible STEMI patients,50 cases of MACE were recorded,Including 12 cardiovascular deaths,4 nonfatal ischemic strokes,4 recurrent MI,15 emergency or elective repeat revascularizations and 15 readmissions for heart failure.Compared with patients without MACE,ones with MACE were older[(63.82±11.88)years vs.(58.84±11.40)years,P=0.009],more likely to have diabetes mellitus(28% vs.18.7%,P<0.001),and more likely to have higher CD14++CD16+ monocyte count[47.17(IQR:23.73,11.35)cell/μL vs.21.47(IQR:12.16,41.87)cell/μL,P<0.001]and fibrinogen[3.580(IQR:3.070,4.580)mg/d L vs.3.190(IQR:2.780,3.570)mg/d L,P<0.001],manifested with lower left ventricular ejection fraction [46.00(IQR:36.00,52.00)%vs.52.00(IQR:45.00,55.00)%,P<0.001],low density lipoprotein-cholesterol[2.410(IQR:1.900,2.950)mmol/L vs.2.770(IQR:2.210,3.350)mmol/L,P=0.003]and estimated glomerular filtration rate[105.50(IQR:80.60,122.8)m L/min/1.73m2 vs.113.0(IQR:98.96,127.7)m L/min/1.73m2,P=0.012].The total monocyte count [558.1(IQR:410.3,718.5)cell/μL vs.506.4(IQR:371.2,662.3)cell/μL],CD14++CD16-monocyte count [425.1(IQR:318.7,566.3)cell/μL vs.362.5(IQR:252.4,487.3)cell/μL] and CD14+CD16++ monocyte count [26.88(IQR:17.75,46.07)cell/μL vs.31.86(IQR:18.21,44.65)cell/μL] has no statistically significant difference between the two groups(all P>0.05).Multivariate Logistic regression analysis showed that the independent predictors for MACE were fibrinogen(OR 4.293,95%CI 1.957-9.418,P<0.001)and left ventricular ejection fraction(OR 2.537,95%CI 1.224-5.259,P= 0.012).Receiver operating characteristic(ROC)curve after multiple logistic regression analyses show that the model incorporating fibrinogen and left ventricular ejection fraction provides the optimal prediction of MACE.The traditional cardiovascular risk stratification model’s discrimination capacities(AUC 0.742,95%CI 0.665-0.819,P<0.001)and calibration(Hosmer-Lemeshow χ2=3.100,P=0.920),Sensitivity of 0.700 and Specificity of 0.643.The model incorporating CD14++CD16+ monocyte and traditional cardiovascular risk factors provides the best prediction of MACE.With clinically acceptable discrimination capacities(AUC 0.800,95%CI 0.727-0.872,P<0.001)and calibration(Hosmer-Lemeshow χ2=3.872,P=0.869)capacities,Sensitivity of 0.680 and Specificity of 0.801.Compared with the traditional cardiovascular risk stratification model for MACE,The model incorporating CD14++CD16+ monocyte show the better discrimination capacities(Δ AUC = 0.258,P=0.016;IDI=0.062,P<0.001;NRI=0.094,P<0.001)and calibration capacities(Hosmer-Lemeshow χ2=2.760,P=0.948).Conclusion:Our study shows that the model incorporating CD14++CD16+ monocyte shows the better discrimination capacities and calibration capacities than the traditional cardiovascular risk stratification model on prediction of MACE in patients with STEMI. |
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