Tahir Ahmad Munir, M Nasir Afzal, Habib -ur- Rehman


Background: The elevated WBC count has been accepted as part of healing response following
myocardial infarction as well as a predictor of adverse cardiovascular events. The study was designed
to find out correlation between WBC count and coronary risk factors, cardiac biomarkers, C-reactive
protein (CRP), incidence of adverse cardiac events and mortality in patients of ACS in Pakistan.
Methods: One hundred and thirty-three patients of ACS were stratified according to WBC categories,
WBC1 (<7000/mm3), WBC2 (7100–10,000/mm3) and WBC3 (>10,000/mm3). The WBCs were
counted on admission by Sysmex cell counter, CRP by immunoturbidimetric method, and CK-MB and
Trop-I by enzyme immunoassay. Adverse cardiac events and mortality were recorded for 12 months of
follow up period. Results: Long term mortality in patients with ACS was 6.4% in WBC1, 18.2% in
WBC2 and 40.9% in WBC3 categories, while short term mortality was 2.6%, 3.0% and 18.2% in
WBC1, WBC2, and WBC3 categories respectively. Relative to patients in lower 2 WBC categories,
patients in the highest category were 7 times more likely to die during 30 days (HR 7.83, p=0.017) and
more than 9 times during the total follow up period (HR 9.42, p<0.001). Cox regression analysis
showed WBC3 a strong independent predictor of mortality (HR 6.36, p=0.016). WBC count showed a
positive correlation with coronary risk factors, cardiac biomarkers and CRP. Conclusion: WBC count
is a strong independent predictor of mortality in patients with ACS and has positive correlation with
coronary risk factors, cardiac biomarkers and CRP.
Keywords: Acute coronary syndrome, WBCs, Mortality, C-reactive protein

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