White blood cell count adds prognostic information to the thrombolysis in myocardial infarction risk index in patients following primary percutaneous coronary intervention (ANIN Myocardial Infarction Registry)

Kruk, Mariusz; Karcz, Maciej; Przyłuski, Jakub; Bekta, Paweł; Kępka, Cezary; Kalińczuk, Łukasz; Pręgowski, Jerzy; Kaczmarska, Edyta; Demkow, Marcin; Chmielak, Zbigniew; Witkowski, Adam; Rużyłło, Witold

doi:10.1016/j.ijcard.2006.03.061

Cited by 13 publications

(18 citation statements)

References 26 publications

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“…This fact concords with previous data correlating leukocytosis with adverse prognosis in STEMI patients treated with primary angioplasty. 6,9,10,18,19 Interestingly, in the current study we observed that the relationship between Hb level and in-hospital mortality was significantly divergent for patients with high and low WBC counts. The adverse impact of high Hb concentration on in-hospital death was restricted to patients with high baseline leukocytosis; interestingly, there was not any trend observed for an increase in death rate in patients with higher Hb levels within the lower leukocytosis stratum.…”

Section: Wbc and Hbmentioning

confidence: 50%

“…On the other hand, higher Hb concentrations are related to increased blood viscosity and a prothrombotic state, which in turn may affect myocardial perfusion and workload, parameters particularly critical in the setting of ACS. 3,6,7 Accordingly, our data indicate a positive correlation between higher Hb levels and increasing peak CK/CK-MB, which suggests increasing infarct size. 14 Anemia or erythrocytosis may also be linked with other conditions that limit survival, such as like inflammatory, pulmonary or bone marrow diseases.…”

Section: Literature Comparisons: Clinical Studiesmentioning

confidence: 50%

“…[1][2][3][4][5] Likewise, inflammatory activation and, in particular, high white blood cell (WBC) count is related to increased risk in those patients. 6,7 Links between anemia and inflammation, or similar, likely synergistic impact of leukocytosis or erythrocytosis on pathophysiological mechanisms associated with adverse clinical course of ACS suggest that there is a potential interaction between WBC count and Hb and outcomes of ACS. [3][4][5][6][7][8][9][10] Despite this, the relationship of leukocytosis and Hb concentration has not been examined in the clinical setting.…”

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confidence: 99%

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Hemoglobin, Leukocytosis and Clinical Outcomes of ST-Elevation Myocardial Infarction Treated With Primary Angioplasty Anin Myocardial Infarction Registry

Kruk¹,

Przyłuski²,

Kalińczuk³

et al. 2009

Circ J

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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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Section: Wbc and Hbmentioning

confidence: 50%

Section: Literature Comparisons: Clinical Studiesmentioning

confidence: 50%

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confidence: 99%

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Hemoglobin, Leukocytosis and Clinical Outcomes of ST-Elevation Myocardial Infarction Treated With Primary Angioplasty Anin Myocardial Infarction Registry

Kruk¹,

Przyłuski²,

Kalińczuk³

et al. 2009

Circ J

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“…The infiltrating inflammatory cells release mediators that modulate smooth muscle cell migration and proliferation as well as further inflammation [1,2]. Elevated inflammatory markers such as total leukocyte count [3,4] and C-reactive protein levels [5,6] are associated with worse outcome after percutaneous coronary artery interventions (PCI). Suppression of innate immunity by various strategies alleviates the inflammatory response following injury and suppresses excessive reactivity, as evidenced by lesser degree of neointimal formation [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Innate immunity has a dual effect on vascular healing: Suppression and aggravation of neointimal formation and remodeling post-endotoxin challenge

et al. 2008

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Background-Inflammation is important to vascular repair following injury, modulating neointimal proliferation and remodeling. Previously, we have shown that a low-intensity inflammatory response aggravates neointimal formation following balloon and stent injury. The present study examined whether modulation of the extent and timing of nonspecific inflammation mediates the local vascular response in an additive unidirectional or rather a bidirectional fashion.Methods and results-Rabbits subjected to denudation and balloon injury of the iliac artery were treated with low(1 µg/kg) or high (100µg/kg) doses of bacterial endotoxin (LPS) immediately after injury, or with early high-dose LPS administered 3 days prior to injury (preconditioning). Neointimal formation at 28 days was significantly increased in the low-dose group (0.537 ± 0.059mm 2 ) as compared with controls (0.3 ± 0.03mm 2 ). High-dose LPS did not significantly affect neointimal formation while early high dose significantly reduced neointima (0.296 ± 0.033 and 0.194 ± 0.025mm 2 , respectively, n = 12-14/group). Arterial wall and systemically circulating interleukin-1β levels, and monocyte CD14 activation correlated with neointimal formation. Vascular remodeling was accelerated in animals treated with low-or high-dose LPS while not affected in the preconditioned group. Remodeling index inversely correlated with arterial matrix metalloproteinase-2 levels 6 days after injury.Conclusions-The extent and timing of nonspecific inflammation that is concurrent with vascular injury can determine different and opposite vascular repair patterns.

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“…[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.…”

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confidence: 99%

Association of Non-Specific Inflammatory Activation With Early Mortality in Patients With ST-Elevation Acute Coronary Syndrome Treated With Primary Angioplasty

Kruk¹,

Przyłuski²,

Kalińczuk³

et al. 2008

Circ J

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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...

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White blood cell count adds prognostic information to the thrombolysis in myocardial infarction risk index in patients following primary percutaneous coronary intervention (ANIN Myocardial Infarction Registry)

Cited by 13 publications

References 26 publications

Hemoglobin, Leukocytosis and Clinical Outcomes of ST-Elevation Myocardial Infarction Treated With Primary Angioplasty Anin Myocardial Infarction Registry

Hemoglobin, Leukocytosis and Clinical Outcomes of ST-Elevation Myocardial Infarction Treated With Primary Angioplasty Anin Myocardial Infarction Registry

Innate immunity has a dual effect on vascular healing: Suppression and aggravation of neointimal formation and remodeling post-endotoxin challenge

Association of Non-Specific Inflammatory Activation With Early Mortality in Patients With ST-Elevation Acute Coronary Syndrome Treated With Primary Angioplasty

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