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Leukocyte count predictive of outcome in patients with STEMI treated with PCI
Palmerini T. Circulation. 2011;doi:10.1161/circulationaha.110.985564.
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In a new analysis of the HORIZONS-AMI trial, white blood cell count was associated with infarct size as well as 1-year cardiac and noncardiac mortality among patients who underwent primary percutaneous coronary intervention for STEMI.
The analysis included all patients from the trial who underwent primary PCI and had available baseline white blood cell (WBC) count (n=3,193). The primary goal of the study was to determine the effect of WBC count on 1-year mortality while additionally looking at its effect on other variables as well, including infarct size.
At 1 year, multivariable analysis, which adjusted for propensity score, suggested WBC count to be an independent predictor of cardiac (HR=1.15; 95% CI, 1.09-1.22) and noncardiac mortality (HR=1.19; 95% CI, 1.10-1.29), as well as major bleeding (HR=1.08; 95% CI, 1.04-1.12). The association with mortality remained, even after adjustment for baseline creatinine phosphokinase (CPK) levels and left ventricular ejection fraction.
The researchers also looked at infarct size, as determined by peak CPK levels, and found that for patients with matched baseline CPK levels at hospital admission, median peak CPK level was substantially higher in patients with high WBC count (>11,000/1 mm3) compared with low WBC count (≤11,000/1 mm3; P<.0001).
“Baseline white blood cell count, which is routinely obtained at the time of admission in patients with ST segment elevation acute myocardial infarction, is an important prognostic predictor of infarct size, major bleeding and cardiac and noncardiac mortality after primary PCI,” the researchers concluded. “Further studies are required to determine whether these associations are causal.”
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