In optimally treated CAD patients influenza vaccination improves the clinical course of CAD and reduces the frequency of coronary ischaemic events. Large-scale studies are warranted to evaluate the effect of influenza vaccination on cardiovascular mortality. (ClinicalTrials.gov: NCT 00371098).

nflammatory activation is inherently related to the development and clinical course of coronary artery disease, 1,2 and regarding non-specific inflammatory indices, baseline leukocytosis has been previously related to increased mortality in unselected cases of ST-elevation myocardial infarction (STEMI) treated with either primary percutaneous coronary intervention (PCI) or thrombolysis. [3][4][5] From among the differential components neutrophils (Ns), lymphocytes (Ls) and the N to L ratio have been also associated with clinical outcomes in STEMI patients. [6][7][8][9][10] With respect to C-reactive protein (CRP), thrombolytic studies show conflicting results [11][12][13] and the data regarding patients treated with primary PCI are limited and do not examine early results in cases of STEMI. [14][15][16][17] Recently, the impact of inflammatory activation on direct worsening of acute clinical outcome in acute coronary syndromes (ACS) has been opposed to stable conditions in coronary disease, highlighting distinct pathomechanisms for both conditions. 1,2 Therefore, the longer term follow-up studies associate inflammatory indices with clinical outcome Circulation Journal Vol.72, February 2008 of STEMI, the more events may be attributed to atherosclerosis progression, leading to dilution and misinterpretation of the true significance of inflammation in the acute phase of STEMI. Moreover, in the advent of conceivable anti-CRP therapy in STEMI, precise determination of its role in humans becomes increasingly important. 18 Therefore, in the present study we investigated the relationship of non-specific inflammatory activation and the immediate outcome of STEMI treated with primary angioplasty. Methods Study PopulationOur study group consisted of 1,078 unselected prospective registry patients enrolled during 2.4 years following April 2002 (with exclusion of 120 patients admitted during a hospital laboratory refurbishment period when routine assay of high-sensitivity CRP (hs-CRP) was not performed off-hours). A predefined set of data for consecutive, unselected patients with STEMI and time from pain onset to admission up to 12 h who are admitted for primary angioplasty have been recorded in a prospective hospital registry since February 2001. 3 STEMI is defined as ST-elevation of ≥0.1 mV in >1 limb leads or ≥0.2 mV in contiguous chest leads or left bundle branch block on presentation.Per institutional requirements, since April 2002 all the patients on admission and prior to any coronary procedures routinely have blood drawn for hs-CRP as well as for differential and white blood cell (WBC) count. In all patients The association of inflammatory markers with mortality in ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) remains controversial, so in the present study the relationships of high-sensitivity C-reactive protein (hs-CRP), total white blood cell (WBC) count, neutrophil (N) and lymphocyte (L) counts and the N/L ratio with occurrence of in-hospital mortality w...

Background Hemoglobin (Hb) levels may interact with inflammatory activation, but it is unknown whether the interaction has any impact on clinical outcomes in acute coronary syndromes. The aim of this study was to assess the relationship between admission Hb levels, leukocytosis and clinical outcomes of ST-elevation myocardial infarction (STEMI) treated with primary angioplasty. Methods and ResultsThe study group comprised 1,904 (1,380 men) patients with STEMI treated with primary percutaneous coronary intervention, enrolled in a prospective registry. The primary endpoint of in-hospital death occurred in 90 (4.7%) patients. According to univariate analysis, extreme values of Hb (for 1 st and 5 th vs mid quintiles respectively: hazard ratio (HR) =7.1, P<0.001 and HR =3.2, P=0.024) and leukocytosis above median (HR =2.09, P=0.001) significantly correlated with in-hospital death. After dividing patients into high and low white blood cell (WBC) count groups, a U-shaped relationship of Hb levels and mortality was observed for patients with higher leukocytosis (1 st and 5 th vs mid quintiles respectively: HR =8.1, P=0.001 and HR =4.4, P=0.022), whereas in patients with lower WBC count higher mortality was related solely to the lowest Hb quintile (HR =6.9, P=0.010 vs mid quintile). Conclusion Higher mortality associated with higher Hb levels in STEMI patients treated with primary angioplasty is limited to patients with increased leukocytosis. (Circ J 2009; 73: 323 -329)

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