Preprocedural White Blood Cell Count as a Predictor of Death and Major Adverse Cardiac Events in Pat
Preprocedural White Blood Cell Count as a Predictor of Death and Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention with Drug-Eluting Stents
Background. Patients with elevated white blood cell (WBC) counts who undergo percutaneous coronary intervention (PCI) are at increased risk for short- and long-term mortality as well as major adverse cardiac events (MACE). We assessed the relationship between elevated WBC counts and clinical events in patients who underwent PCI with drug-eluting stents (DES).
Methods. Our retrospective study includes 878 consecutive patients who underwent both elective and emergent PCI with DES at the UCLA Medical Center. The cohort was divided into tertiles based upon the presenting WBC count: 2.8–6.3 × 109 cells/L (tertile 1 [T1]), 6.4–8.7 × 109 cells/L (tertile 2 [T2]), ≥ 8.8 × 109 cells/L (tertile 3 [T3]).
Results. Survival at 1 year was significantly different between all three tertiles, and was poorest in patients with WBC counts in T3 (93.9%-T1, 98.4%-T2, 87.3%-T3; p < 0.0001), while T2 had the highest survival rate at 1 year. Age, chronic renal insufficiency, chronic obstructive pulmonary disease, low WBC count in T1, elevated WBC count in T3 and presentation with myocardial infarction were identified as multivariable predictors for survival at 1 year.
Conclusion. Both elevated and low WBC counts are associated with increased mortality and MACE at 1 year following PCI with DES. WBC count is an independent predictor of survival in patients who undergo PCI with DES implantation.
Inflammation plays a key role in arterial atherogenesis and the development of myocardial infarction (MI). The white blood cell (WBC) count, a standardized, available and inexpensive measure of systemic inflammation, is an independent predictor of cardiovascular disease and all-cause mortality. Clinical and epidemiologic studies have shown the leukocyte count to be an independent risk factor for coronary artery disease (CAD), future cardiovascular events in individuals without CAD and a prognostic indicator of future events in patients with CAD. Moreover, patients with elevated WBC counts are at greater risk for adverse events in the acute setting and have higher short- and long-term mortality rates. A study of ST-elevation myocardial infarction (STEMI) patients reported that the WBC count provided independent and additional predictive value to 30-day mortality risk stratification when added to the thrombolysis in myocardial infarction (TIMI) risk index compared to the TIMI risk index alone. Proposed mechanisms responsible for this association include leukocyte-mediated no-reflow, a leukocyte-mediated hypercoagulable state and indirect cardiotoxicity mediated through proinflammatory cytokines.
While the association between elevated WBC count and worse clinical outcomes has been well demonstrated with fibrinolysis, primary angioplasty and percutaneous coronary intervention (PCI) with bare-metal stents (BMS), there is a paucity of data demonstrating the association between WBC count and mortality in PCI with drug-eluting stents (DES). The goal of the study was to evaluate the relationship between WBC count and survival in the setting of PCI with DES implantation.
Abstract and Introduction
Abstract
Background. Patients with elevated white blood cell (WBC) counts who undergo percutaneous coronary intervention (PCI) are at increased risk for short- and long-term mortality as well as major adverse cardiac events (MACE). We assessed the relationship between elevated WBC counts and clinical events in patients who underwent PCI with drug-eluting stents (DES).
Methods. Our retrospective study includes 878 consecutive patients who underwent both elective and emergent PCI with DES at the UCLA Medical Center. The cohort was divided into tertiles based upon the presenting WBC count: 2.8–6.3 × 109 cells/L (tertile 1 [T1]), 6.4–8.7 × 109 cells/L (tertile 2 [T2]), ≥ 8.8 × 109 cells/L (tertile 3 [T3]).
Results. Survival at 1 year was significantly different between all three tertiles, and was poorest in patients with WBC counts in T3 (93.9%-T1, 98.4%-T2, 87.3%-T3; p < 0.0001), while T2 had the highest survival rate at 1 year. Age, chronic renal insufficiency, chronic obstructive pulmonary disease, low WBC count in T1, elevated WBC count in T3 and presentation with myocardial infarction were identified as multivariable predictors for survival at 1 year.
Conclusion. Both elevated and low WBC counts are associated with increased mortality and MACE at 1 year following PCI with DES. WBC count is an independent predictor of survival in patients who undergo PCI with DES implantation.
Introduction
Inflammation plays a key role in arterial atherogenesis and the development of myocardial infarction (MI). The white blood cell (WBC) count, a standardized, available and inexpensive measure of systemic inflammation, is an independent predictor of cardiovascular disease and all-cause mortality. Clinical and epidemiologic studies have shown the leukocyte count to be an independent risk factor for coronary artery disease (CAD), future cardiovascular events in individuals without CAD and a prognostic indicator of future events in patients with CAD. Moreover, patients with elevated WBC counts are at greater risk for adverse events in the acute setting and have higher short- and long-term mortality rates. A study of ST-elevation myocardial infarction (STEMI) patients reported that the WBC count provided independent and additional predictive value to 30-day mortality risk stratification when added to the thrombolysis in myocardial infarction (TIMI) risk index compared to the TIMI risk index alone. Proposed mechanisms responsible for this association include leukocyte-mediated no-reflow, a leukocyte-mediated hypercoagulable state and indirect cardiotoxicity mediated through proinflammatory cytokines.
While the association between elevated WBC count and worse clinical outcomes has been well demonstrated with fibrinolysis, primary angioplasty and percutaneous coronary intervention (PCI) with bare-metal stents (BMS), there is a paucity of data demonstrating the association between WBC count and mortality in PCI with drug-eluting stents (DES). The goal of the study was to evaluate the relationship between WBC count and survival in the setting of PCI with DES implantation.
