BASELINE LEUKOCYTE COUNT AND ACUTE CORONARY SYNDROME: PREDICTOR OF ADVERSE CARDIAC EVENTS, LONG AND SHORT TERM MORTALITY AND ASSOCIATION WITH TRADITIONAL RISK FACTORS, CARDIAC BIOMARKERS AND CREACTIVE PROTEIN

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

Abstract


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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References


Haim M, Boyko V, Goldbourt U, Battler A, Behar S.

Predictive value of elevated white cell count in patients with

preexisting coronary heart disease. Arch Intern Med

;164:433–9.

Natalie K, Wolfgang K. Biomarkers of outcome from

cardiovascular disease. Curr Opin Crit Care 2006;12:412–9.

Grzybowski M, Welch RD, Parson L, Ndumele CE, Chen E,

Zalenski R, et al. The association between white blood cell

count and acute myocardial infarction in hospital mortality:

finding from the National Registry of myocardial infarction.

Acad Emerg Med 2004;11:1049–60.

Madjid M, Awan I, Willerson JT, Casscells SW. Leukocyte

count and coronary heart disease implications for risk

assessment. J Am Coll Cardiol 2004:44;1945–56.

Nunez J, Nunez E, Sanchis J, Bodi V, Llacer A. Prognostic

value of leukocytosis in acute coronary syndrome: the

Cinderella of the inflammatory markers. Curr Med Chem

;13:2113–8.

Laurie GF, Lamberg L. The leukocyte count, a measure and

predictor of coronary events. Am J Crit Care 2007;16:401–4.

Myocardial infarction redefined. A consensus document of

the joint European Society of Cardiology / American College

of Cardiology Committee for the redefinition of myocardial

infarction. Eur Heart J 2000;21:1502–13.

Haines AP, Howarth D, North WR, Goldenberg E, Stirling

Y, Meade TW, et al. Haemostatic variables and the outcome

of myocardial infarction. Thromb Haemost 1985;50:800–3.

Cannon CP, McCabe CH, Wilcox RG, Bentely JH,

Braunwald E. Association of white blood cell count with

increase mortality in acute myocardial infarction and unstable

angina pectoris. OPUS-TIMI 16 Investigators. Am J Cardiol

;87:636–9.

Ndrepepa G, Braun S, Lijima R, Keta D, Byrne RA, Schulz

S, et al. Total leukocyte count but not C-reactive protein

predicts one year mortality in patients with acute coronary

syndromes treated with percutaneous coronary intervention.

Clin Sci (Lond) 2009;116:651–8.

Muller C, Neumann FJ, Perruchoud AP, Buettner HJ. White

blood cell count and long term mortality after non-ST

elevation acute coronary syndrome treated with very early

revascularization. Heart 2003;89:389–92.

Hung MJ, Cherng WJ. Comparison of white cell count in

acute myocardial infarction patients with significant and

insignificant coronary artery disease. Am J Cardiol

;91:1339–42.

Morange PE, Simon C, Alessi MC, Luc G, Arveiler D,

Ferrieres J, et al. Endothelial cell markers and risk of

coronary heart disease: the prospective epidemiological study

of myocardial infarction (PRIME) study. Circulation

;109:1343–8.

Avramkis G, Papadimitraki E, Papakonstandinou D, Liakou

K, Zidianakis M, Dermitzakis A , et al. Platelets and white

cell subpopulations among patients with myocardial

infarction and unstable angina. Platelets 2007;18:16–23.

Byrne CE, Fitzgerald A, Canon CP, Fitzgerald DJ, Sheilds

DC. Elevated white cell count in acute coronary syndromes:

relationship to variants in inflammatory and thrombotic

genes. BMC Med Genet 2004;5:13.

Malika V, Goswami B, Rajappa M. Atherosclerosis pathophysiology and the role f noval risk factors: a clinicochemical

perspective. Angiology 2007;58:513–22.

Etrl G, Frantz S. Wound model of myocardial infarction. Am

J Physiol Heart Circ Physiol 2005;288:H981–3.

Capuano V, Lamaida N, DeMartino M, Mazzotta G.

Association between white blood cell count and risk factors

of coronary artery disease. G Ital Cardiol 1995;25:1145–52.


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