Total leukocyte count but not C-reactive protein predicts one-year mortality in patients with acute coronary syndromes treated with percutaneous coronary intervention
Résumé
Although an association between elevated white blood cells (WBC) count and mortality in patients with acute coronary syndromes (ACS) has been established, the independence of this association from coronary risk factors and C-reactive protein has been inadequately studied. This prospective registry included 4329 patients with ACS treated with percutaneous coronary intervention (PCI): 1059 patients with ST-segment elevation acute myocardial infarction, 1753 patients with non-ST-segment elevation acute myocardial infarction and 1517 patients with unstable angina. Blood samples were obtained before angiography for WBC count and C-reactive protein measurements. The primary outcome of this analysis was 1-year mortality. At one year, 345 patients (8%) died: 45 patients in the 1st tertile, 93 patients in the 2nd tertile and 207 patients in the 3rd tertile of WBC count (Kaplan-Meier estimates of mortality, 3.2%, 6.4% and 14.1% with an odds ratio [OR]=2.42, 95% confidence interval [1.78-3.12], P<0.001 for tertile 3 vs tertile 2 and an OR of 1.99, [1.77-2.25], P<0.001 for tertile 2 vs tertile 1). The Cox proportional hazards model adjusting for coronary risk factors, ASC presentation, extent of coronary artery disease, C-reactive protein and other covariates identified WBC count with a hazard ratio [HR]=1.05 (95% confidence interval [CI] 1.02-1.07; P<0.001 for 1000 cells/mm3 increase in the WBC count) but not C-reactive protein (HR=1.13, 95% CI 0.95-1.34; P=0.15 for 1 tertile increase in the C-reactive protein concentration) as an independent correlate of 1-year mortality. We conclude that elevated WBC count but not C-reactive protein predicts one-year mortality independent of cardiovascular risk factors across the entire spectrum of patients with ACS treated with PCI.
Origine : Fichiers produits par l'(les) auteur(s)
Loading...