Leukocyte Count as Predictor of Angiographic Findings and Clinical Events in Non-ST-Segment Elevation Acute Coronary Syndromes. Sub-analysis of the PACS Angiographic Study

Alfredo Hirschon Prado, Gaston Vazquez, José Navarro Estrada, Enrique Dominé, Pablo Merlo, Fernando Botto, Jorge Mrad, Florencia Rolandi

Abstract


BackgroundPrevious studies have analyzed the relationship between inflammatory markers andacute coronary syndromes. Prognosis in Acute Coronary Syndromes (PACS) was aprospective, multicentric study conducted between January 2000 and May 2002 in11 coronary care units of Argentina. It determined the prognostic value of differentbiomarkers, alone or in combination, to stratify risk in patients with non-STsegmentelevation acute coronary syndromes (NSTEACS). However, there are fewstudies on the relationship of increased leukocyte levels with angiographic findingsand mid-term events.ObjectiveThe aim of the study was to establish whether leukocyte count at admission is associatedwith complex coronary disease and adverse prognosis at 6-month follow-upin patients with NSTEACS.MethodsThe angiographic PACS substudy was conducted in 1253 patients from the corePACS study cohort (with a total population of 1500 patients) and it included centerswith coronary angiography facilities (CA). Out of the 1253 substudy patients, CA wasperformed in 633 patients (50.5%) (mean of 48 hours after admission, percentiles25-75, 24-72 hours).To perform the sub-analysis, complete data were obtained from 580 patients (46.2%).In this group, leukocyte count within 24 hours of admission was analyzed in additionto tests performed in the biomarker PACS protocol. The population was divided inpercentiles according to admission leukocyte count. Patients with initial leukocytes< 7700/mm 3 were included in the lower percentile, patients with leukocyte count between7700 and 11500/mm 3 in the middle percentile and those with leukocyte count> 11500/mm 3 in the higher percentile.ResultsMost of the 580 patients were men (72.9%), and mean age was 66±12 years. Amongthese patients, 64.4% had history of hypertension, 17.9% of diabetes, 22.2% of previousinfarction, 60% presented high clinical risk (ACC/AHA) and 61.1% had ECG atadmission with ST-segment or T wave alterations. Leukocyte count > 11500/mm 3was associated with higher rate of visible thrombus, presence of complicated plaqueand more extensive coronary disease (p = 0.019, 0.033 and 0.07, respectively). At the6-month follow-up, patients in the higher percentile had greater tendency of death orinfarction than patients in the lower percentile (14.2% vs. 7.5%; p = 0.026).ConclusionIn patients with NSTEACS, a high leukocyte count at admission is associated withcomplex coronary disease and worse prognosis at 6 months.

References


Bibliografía:

Kirbis S, Breskvar UD, Sabovic M, Zupan I, Sinkovic A.Inflammation markers in patients with coronary artery disease--comparison of intracoronary and systemic levels. Wien Klin Wochenschr. 2010 May;122 Suppl 2:31-4.

Ross R. Atherosclerosis – an inflammatory disease. N Engl J Med 1999;340:115–26.

Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis.Circulation 2002;105:1135–43

Brunetti ND, Munno I, Pellegrino PL, Ruggero V, Correale M, De Gennaro L, Cuculo A, Campanale EG, Di Biase M. Inflammatory cytokines imbalance in the very early phase of acute coronary syndrome: correlations with angiographic findings and in-hospital events.Inflammation. 2011 Feb;34(1):58-66.

Ray KK, Nazer B, Cairns R, Michael Gibson C, Cannon CP. Association between percutaneous coronary intervention and long-term C-reactive protein levels in patients with acute coronary syndromes. J Thromb Thrombolysis. 2010 Jul;30(1):10-3.

Borges FK, Borges FK, Stella SF, Souza JF, Wendland AE, Werres Junior LC, Ribeiro JP, Polanczyk CA. Serial analyses of C-reactive protein and myeloperoxidase in acute coronary syndrome. Clin Cardiol. 2009 Nov;32(11):E58-62.

Ikonomidis I, Michalakeas CA, Lekakis J, Paraskevaidis I, Kremastinos DT.Multimarker approach in cardiovascular risk prediction. Dis Markers. 2009;26(5-6):273-85.

Giugliano G, Brevetti G, Lanero S, Schiano V, Laurenzano E, Chiariello M.Leukocyte count in peripheral arterial disease: A simple, reliable, inexpensive approach to cardiovascular risk prediction.Atherosclerosis. 2010 May;210(1):288-93. Epub 2009 Nov 11.

Núñez J, Núñez E, Sanchis J, Bodí V, Llàcer A. Prognostic value of leukocytosis in acute coronary syndromes: the cinderella of the inflammatory markers.Curr Med Chem. 2006;13(18):2113-8.

Huang G, Zhong XN, Zhong B, Chen YQ, Liu ZZ, Su L, Ling ZY, Cao H, Yin YH.Significance of white blood cell count and its subtypes in patients with acute coronary syndrome Eur J Clin Invest. 2009 May;39(5):348-58.

Ferreirós ER, Boissonnet CP, Pizarro R, Merletti PF, Corrado G, Cagide A, Bazzino OO. Independent prognostic value of elevated C-reactive protein in unstable angina. Circulation. 1999 Nov 9;100(19):1958-63.

Oscar Bazzino, Juan J Fuselli, Fernando Botto, Diego Perez De Arenaza, Cecilia Bahit, Jorge Dadone, Relative value of N-terminal probrain natriuretic peptide, TIMI risk score, ACC/AHA prognostic classification and other risk markers in patients with non-ST-elevation acute coronary syndromes. European Heart Journal (2004) Volume: 25, Issue: 10, Pages: 859-866

Navarro Estrada JL, Gabay JM, Alvarez J, Sztejfman C, Matas CR, Farrás A, Sarmiento R, Tettamanzi A, Rapallo C, Mrad J, Botto F, Hirschson-Prado A, De Miguel R, Guzmán LA; PACS. Relation of C-reactive protein to extent and complexity of coronary narrowing in patients with non-ST elevation acute coronary syndromes. A prospective cohort study. Coron Artery Dis. 2004 Dec;15(8):477-84.

Alderman EL, Kip KE, Whitlow PL, Bashore T, Fortin D, Bourassa MG, Lesperance J, Schwartz L, Stadius M. Native coronary disease progression exceeds failed revascularization as cause of angina after five years in the Bypass Angioplasty Revascularization Investigation. J Am Coll Cardiol. 2004;44(4):766

Kastrati A, Schömig A, Elezi S, Dirschinger J, Mehilli J,et al. Prognostic Value of the Modified American College of Cardiology/ American Heart Association Stenosis Morphology Clasification for Long-Term Angiographic and Clinical Outcome After Coronary Stent Placement. Circulation. 1999; 100: 1285-90.

Bazzino O, Natale E. Prognostic value of C-reactive protein in ischemic cardiopathy, Medicina (B Aires). 2001;61(2):239-4

Bazzino O, Ferreirós ER, Pizarro R, Corrado G.C-reactive protein and the stress tests for the risk stratification of patients recovering from unstable angina pectoris. Am J Cardiol. 2001 Jun 1;87(11):1235-9.

Paul Wood's. Disease of the Heart and Circulation, Tercera edición 1968, Eyre & Spottiswoode, London, pagina 844

Sakai T, Inoue S, Matsuyama TA, Takei M, Ota H, Katagiri T, Koboyashi Y. Eosinophils may be involved in thrombus growth in acute coronary syndrome. Int Heart J. 2009 May;50(3):267-77.

Jurewitz DL, Pessegueiro A, Zimmer R, Bhatia R, Tobis J, Lee MS. 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. J Invasive Cardiol. 2009 May;21(5):202-6.

Huang G, Zhong XN, Zhong B, Chen YQ, Liu ZZ, Su L, Ling ZY, Cao H, Yin YH. Significance of white blood cell count and its subtypes in patients with acute coronary syndrome. Eur J Clin Invest. 2009 May;39(5):348-58.

Mehran R, Pocock SJ, Nikolsky E, et al. A risk score to predict bleeding in patients with acute coronary syndromes J Am Coll Cardiol 2010;55:2556-2566


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar