Association Among Leukocyte Count, Mortality, and Bleeding in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes (from the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY] Trial)

doi:10.1016/j.amjcard.2012.12.056

The American Journal of Cardiology

Volume 111, Issue 9, 1 May 2013, Pages 1237-1245

https://doi.org/10.1016/j.amjcard.2012.12.056 Get rights and content

Although inflammation is involved in the pathogenesis of acute coronary syndromes, the extent of inflammation is not routinely assessed, and its prognostic implications in patients with non–ST-segment elevation acute coronary syndrome have not been investigated in depth. We analyzed the prognostic implications of an elevated white blood cell count (WBCc) in patients with moderate and high-risk non–ST-segment elevation acute coronary syndrome undergoing an early invasive strategy in the large-scale Acute Catheterization and Urgent Intervention Triage StrategY trial. The WBCc at admission was available for 13,678 of 13,819 patients (98.9%). The patients in the upper tertile of the WBCc had an increased risk of 30-day major bleeding, 1-year mortality, and definite/probable stent thrombosis compared to those in the mid or lower tertiles. On multivariate analysis, the WBCc was an independent predictor of 30-day major bleeding and 1-year cardiac, noncardiac, and all-cause mortality. The association between the WBCc and cardiac mortality was present in multiple prespecified subgroups, with no significant interaction between the WBCc and age, gender, diabetes, smoking, renal dysfunction, elevated baseline biomarkers, antithrombotic therapy, revascularization, and Thrombolysis In Myocardial Infarction risk score. The WBCc remained an independent predictor of mortality after adjusting for bleeding, C-reactive protein level, and angiographic variables, including left ventricular ejection fraction, Thrombolysis In Myocardial Infarction flow, and number of diseased vessels. The WBCc significantly improved the prognostic accuracy of the Thrombolysis In Myocardial Infarction risk score, with a net reclassification improvement of 11% (p <0.0001). In conclusion, in patients with moderate- and high-risk non–ST-segment elevation acute coronary syndrome, an elevated admission WBCc was an independent predictor of 30-day major bleeding, and 1-year cardiac, noncardiac, and all-cause mortality.

Section snippets

Methods

The ACUITY trial design has been previously reported in detail.⁷ In brief, the ACUITY trial was a multicenter, prospective randomized trial of patients with moderate- and high-risk NSTE-ACS who were treated with an early invasive strategy. Patients were randomly assigned before coronary angiography to heparin (unfractionated or low-molecular-weight) plus a glycoprotein IIb/IIIa inhibitor, bivalirudin plus a glycoprotein IIb/IIIa inhibitor, or bivalirudin monotherapy with provisional

Results

Of the 13,819 patients enrolled in the ACUITY trial, 13,678 (98.9%) had a baseline WBCc available and represented the present study cohort. The clinical characteristics of the patients stratified by WBCc tertiles are listed in Table 1. The patients in the greater WBCc tertile were younger and were more likely to be smokers and to have elevated cardiac biomarkers or ST-segment deviation ≥1 mm but were less likely to have had previous MI, percutaneous coronary intervention, or coronary artery

Discussion

The major findings of the present study were, first, that the baseline WBCc measured at hospital presentation in patients with NSTE-ACS was an independent predictor of 30-day major bleeding and 1-year all-cause mortality, cardiac mortality, and noncardiac mortality. Second, an increased baseline WBCc was associated with greater mortality and cardiac mortality both within the first 30 days and from 30 days to 1 year. Third, the relation between the WBCc and both mortality and cardiac mortality

Disclosures

The authors have no conflicts of interest to disclose.

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The Prognostic Significance of Leukocyte Count on All-Cause and Cardiovascular Disease Mortality: A Systematic Review and Meta-Analysis
2023, American Journal of Cardiology
White blood cells (WBCs) act as mediators of inflammatory responses and are commonly measured in hospitals. Although several studies have reported a relation between WBC count and mortality, no systematic review or meta-analysis has been conducted. This study aimed to identify an association between WBC count and mortality. We conducted a systematic search on Embase using keywords such as “white blood cell” and “mortality.” We analyzed the hazard ratios (HRs) for WBC count of 1.0 × 10⁹ cells/L regarding 2 criteria: the cause of mortality and the follow-up period. A total of 13 of 222 articles comprising a total of 62,904 participants were included in this study, meeting the criteria set. A positive association was observed between WBC count and mortality, as indicated by an HR of 1.10 (95% confidence interval [CI] 1.08 to 1.13). In additionally, WBC count emerged as a significant predictor of mortality in both groups, with an HR of 1.10 (95% CI 1.07 to 1.12) for patients with cardiovascular disease and an HR of 1.12 (95% CI 1.07 to 1.17) for the general population or patients with COVID-19. Furthermore, a higher WBC count demonstrated a significant association with long-term all-cause mortality (HR 1.09, 95% CI 1.07 to 1.12) and long-term cardiovascular mortality (HR 1.05, 95% CI 1.02 to 1.07). Similarly, a significant association was found between higher WBC count and short-term all-cause mortality (HR 1.12, 95% CI 1.09 to 1.16) and cardiovascular mortality (HR 1.12, 95% CI 1.07 to 1.17). Further research is necessary to explore the relation between WBC count and disease progression or death and to establish causality between elevated WBC count and disease progression.
VWF, CXCL8 and IL6 might be potential druggable genes for acute coronary syndrome (ACS)
2019, Computational Biology and Chemistry
Citation Excerpt :
As we known, the leukocyte count is a surrogate marker of inflammation (Kaartinen et al., 1998). Palmerini et al have demonstrated that the leukocyte count is an attractive marker for potential risk stratification of patients with NSTE-ACS because of its low cost and routine assessment at hospital admission (Palmerini et al., 2013). Meanwhile, Furman et al also indicate that platelet activation and markers of leukocyte have been associated with coronary artery disease and ACS (Furman et al., 2004).
Acute coronary syndrome (ACS) is currently a leading cause of morbidity and mortality worldwide. This study aimed to screen critical genes and miRNAs involved in ACS.
Microarray data (access number GSE19339) was downloaded from Gene Expression Omnibus (GEO) database. After data preprocessing, we screened the differentially expressed genes (DEGs) using limma package and subsequently performed enrichment analysis using DAVID tool. The protein-protein interaction (PPI) network and transcription factor (TF)-miRNA-target gene regulatory network were visualized using Cytoscape software. Finally, the drug-gene interactions were predicted using DGIdb database.
A total of 425 DEGs were identified in ACS samples compared with healthy control samples. Functional enrichment analysis showed that DEGs were mainly involved in angiogenesis, inflammatory response and PI3K-Akt signaling pathway. IL6 and VEGFA were key nodes in PPI network. In addition, hsa-miR-29, hsa-miR-1, NFIC, NFKB1 and RELA were identified as key factors in TF-miRNA-target gene network. Finally, the prediction results revealed that VWF, CXCL8 and IL6 had higher degree than other genes.
IL6 and VEGFA might play major roles in ACS progression. Two miRNAs (hsa-miR-29 and hsa-miR-1) and three TFs (NFIC, NFKB1 and RELA) were critical genes involved in pathological process of ACS. VWF, CXCL8 and IL6 might be potential druggable genes for ACS therapy.
Prognostic significance of mean platelet volume in diabetic patients with ST-elevation myocardial infarction
2014, Journal of Diabetes and its Complications
Citation Excerpt :
These patients are particularly at risk of major adverse cardiovascular events. The association between erythrocyte count, leukocyte count and STEMI has been extensively studied (Lopes et al., 2012; Palmerini et al., 2011; Palmerini et al., 2013; Willis & Voeltz, 2009). The experimental data support the central role of platelets.
Mean platelet volume (MPV) is a universally available parameter with routine blood counts. It has been linked to many cardiovascular risk factors. MPV is a marker of platelet size and activity and has been linked to poor prognosis following STEMI. There has been an increasing number of reports linking diabetes mellitus (DM) to platelet dysfunction. The aim of the study was to examine the association between admission MPV and clinical outcomes in patients with DM and STEMI undergoing primary percutaneous coronary intervention (PCI). The secondary objective of the study was to evaluate whether this index can be used to determine the long-term prognosis.
A total of 1,557 patients with STEMI undergoing primary PCI were enrolled and divided into two groups depending on their diabetes mellitus status: Group 1 – patients with diabetes mellitus (N = 539) and Group 2 – patients without diabetes mellitus (N = 1018).
MPV and peak CK-MB concentration were higher in diabetic patients as compared to non-diabetic patients. In diabetic patients, MPV was positively correlated with admission Killip class and negatively correlated with time to death during follow-up, initial TIMI flow, final TIMI flow, and erythrocyte count. In non-diabetic patients, MPV was positively correlated with the number of diseased coronary arteries, admission Killip class, and negatively correlated with time to death during follow-up and initial TIMI flow. ROC analysis revealed high diagnostic value of MPV in predicting in-hospital and one-year mortality. MPV cut-off level was lower for diabetic patients compared to non-diabetic patients.
Diabetic patients had higher MPV than non-diabetic patients. Both in diabetic and non-diabetic patients MPV proved to have good prognostic value for in-hospital and late mortality. MPV cut-off value for predicting mortality was lower in diabetic patients. Mortality rate was the highest in the fourth quartiles of MPV in both study groups.
White blood cell count and clinical outcomes after left main coronary artery revascularization: Insights from the EXCEL trial
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Impact of clinical presentation on bleeding risk after percutaneous coronary intervention and implications for the ARC-HBR definition
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View all citing articles on Scopus

: The ACUITY trial was funded by The Medicines Company, (Parsippany, New Jersey), and Nycomed (Roskilde, Denmark).

: See page 1244 for disclosure information.

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Coronary artery diseaseAssociation Among Leukocyte Count, Mortality, and Bleeding in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes (from the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY] Trial)

Section snippets

Methods

Results

Discussion

Disclosures

Am J Cardiol

Am Heart J

J Am Coll Cardiol

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Atherosclerosis—an inflammatory disease

N Engl J Med

The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study

JAMA

White blood cell count and long term mortality after non-ST elevation acute coronary syndrome treated with very early revascularisation

Heart

Coronary artery disease
Association Among Leukocyte Count, Mortality, and Bleeding in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes (from the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY] Trial)