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Erythrocyte sedimentation rate in acute myocardial infarction as a predictor of poor prognosis and impaired reperfusion.

AIM
To investigate whether the elevated erythrocyte sedimentation rate (ESR) is associated with an adverse prognosis in the patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).


METHODS
It included 140 consecutive patients undergoing primary PCI for acute STEMI, 12 hours after symptom beginning and 50 healthy age and sex matched control subjects. All patients were categorized into two groups defined by the median ESR level on admission. These two groups were compared in terms of myocardial perfusion, and one year outcomes.


RESULTS
Levels of ESR were higher in patients with STEMI than in the healthy group. Patients in the elevated ESR group had a higher incidence of impaired angiographic reperfusion compared to patients in the lower ESR group (Mean TIMI frame count; 25.5 ± 6.5 versus 20.4 ± 5.2, p0.01, TMPG 0-2; 55 % versus 29%, p0.01). In-hospital and one-year mortality rates were significantly higher in patients with higher ESR. In-hospital and one-year MACE rates were significantly greater in elevated ESR group (14%-26), compared to the lower ESR group (4%-13%). Increased ESR levels on admission emerged as independent predictors of long term prognosis. The ROC analysis revealed an optimal cut-point of ≥ 33 mm/h, detected 1 year mortality with a negative predictive value of 96%.


CONCLUSION
The high admission ESR levels are found to be related with impaired coronary flow in patients undergoing primary PCI that possibly contribute to poor short- and long-term prognosis. Therefore, admission ESR evaluation may be helpful in identifying patients with a poor prognosis.