Abstract
Background
Inflammation plays a key role in the pathogenesis of acute coronary syndromes (ACS). In this context we assessed neutrophil count as a predictor of major in‐hospital events in patients admitted for a non‐ST‐segment elevation (NSTE) ACS.
Methods
We measured neutrophils on admission in 160 patients with a NSTE ACS and we correlated their count with the incidence of a combined in‐hospital end point including: cardiac death, acute heart failure, ST‐segment elevation myocardial infarction, and recurrent myocardial ischemia.
Results
Patients who had a major in‐hospital event also had a higher neutrophil count (P = 0.02) and higher serum levels of troponin I (P = 0.04). In the univariate logistic regression analysis, in‐hospital major events could be predicted by troponin I > 0.07 ng/mL (odds ratio [OR]: 5.65, 95% confidence interval [CI]: 1.26–25.32, P = 0.02), white blood cell count > 8650 cells/µL (OR: 2.68, 95% CI: 1.03–6.95, P = 0.04), neutrophil count > 6700 cells/µL (OR: 7.74, 95% CI: 2.79–21.47, P < 0.001), and C‐reactive protein > 0.97 mg/dL (OR: 3.56, 95% CI: 1.13–11.19, P = 0.02). However, in multivariate regression, neutrophil count > 6700 cells/µL (OR: 6.52, 95% CI: 1.56–27.22, P = 0.01) was the only independent in‐hospital prognostic factor.
Conclusions
In patients with a NSTE ACS of moderate or high risk, neutrophil count on admission may identify those who are at risk of having an adverse in‐hospital outcome. Copyright © 2009 Wiley Periodicals, Inc.
Full Text
The Full Text of this article is available as a PDF (1.4 MB).
References
- 1. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med 1999; 340: 115–126. [DOI] [PubMed] [Google Scholar]
- 2. Danesh J, Collins R, Appleby P, et al. Association of fibrinogen, C‐reactive protein, albumin, or leukocyte count with coronary heart disease: meta‐analyses of prospective studies. JAMA 1998; 279: 1477–1482. [DOI] [PubMed] [Google Scholar]
- 3. Ernst E, Hammerschmidt DE, Bagge U, et al. Leukocytes and the risk of ischemic diseases. JAMA 1987; 257: 2318–2324. [PubMed] [Google Scholar]
- 4. Sabatine MS, Morrow DA, Cannon CP, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS‐TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy–Thrombolysis In Myocardial Infarction 18 trial) substudy. J Am Coll Cardiol 2002; 40: 1761–1768. [DOI] [PubMed] [Google Scholar]
- 5. Mehta J, Dinerman J, Mehta P, et al. Neutrophil function in ischemic heart disease. Circulation 1989; 79: 549–556. [DOI] [PubMed] [Google Scholar]
- 6. Dinerman JL, Mehta JL, Saldeen TG, et al. Increased neutrophil elastase release in unstable angina pectoris and acute myocardial infarction. J Am Coll Cardiol 1990; 15: 1559–1563. [DOI] [PubMed] [Google Scholar]
- 7. Biasucci LM, Donofrio G, Liuzzo G, et al. Intracellular neutrophil myeloperoxidase is reduced in unstable angina and acute myocardial infarction, but its reduction is not related to ischemia. J Am Coll Cardiol 1996; 27: 611–616. [DOI] [PubMed] [Google Scholar]
- 8. Antman EM, Papadaki OA, Manousakis SJ, et al. The TIMI risk score for unstable angina/non ST segment elevation myocardial infarction: a method for prognostication and therapeutic decision making. JAMA 2000; 284: 835. [DOI] [PubMed] [Google Scholar]
- 9. Yan A, Yan R, Tan M, et al. Risk scores for risk stratification in acute coronary syndromes: useful but simpler is not necessarily better. Eur Heart J 2007; 28: 1072–1078. [DOI] [PubMed] [Google Scholar]
- 10. Hamm CW, Ravkilde J, Gerhardt W, et al. The prognostic value of serum troponin T in unstable angina. N Engl J Med 1992; 327: 146–150. [DOI] [PubMed] [Google Scholar]
- 11. Antman EM, Tanasijevic MJ, Thompson B, et al. Cardiac specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996; 335: 1342–1349. [DOI] [PubMed] [Google Scholar]
- 12. Ridker PM. Clinical application of C‐reactive protein for cardiovascular disease detection and prevention. Circulation 2003; 107: 363–369. [DOI] [PubMed] [Google Scholar]
- 13. Lindahl B, Toss H, Siegbahn A, et al. Markers of myocardial damage and inflammation in relation to long‐term mortality in unstable coronary artery disease. N Engl J Med 2000; 343: 1139–1147. [DOI] [PubMed] [Google Scholar]
- 14. Biasucci L, Liuzzo G, Grillo R, et al. Elevated levels of C‐reactive protein at discharge in patients with unstable angina predict recurrent instability. Circulation 1999; 99: 855–860. [DOI] [PubMed] [Google Scholar]
- 15. Zalokar JB, Richard JL, Claude JR. Leukocyte count, smoking, and myocardial infarction. N Engl J Med 1981; 304: 465–468. [DOI] [PubMed] [Google Scholar]
- 16. Kannel WB, Anderson K, Wilson PW. White blood cell count and cardiovascular disease: insights from the Framingham Study. JAMA 1992; 267: 1253–1256. [PubMed] [Google Scholar]
- 17. Barron HV, Harr SD, Radford MJ, et al. The association between white blood cell count and acute myocardial infarction mortality in patients ≥ 65 years of age: findings from the cooperative cardiovascular project. J Am Coll Cardiol 2001; 38: 1654–1661. [DOI] [PubMed] [Google Scholar]
- 18. Mueller C, Neumann FJ, Perruchoud AP, et al. White blood cell count and long term mortality after non‐ST elevation acute coronary syndrome treated with very early revascularization. Heart 2003; 89: 389–392. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Haines AP, Howarth D, North WR, et al. Haemostatic variables and the outcome of myocardial infarction. Thromb Haemost 1983; 50: 800–803. [PubMed] [Google Scholar]
- 20. Furman MI, Becker RC, Yarzebski J, et al. Effect of elevated leukocyte count on in‐hospital mortality following acute myocardial infarction. Am J Cardiol 1996; 78: 945–948. [DOI] [PubMed] [Google Scholar]
- 21. Wong CK, French JK, Gao W, et al. Relationship between initial white blood cell counts, stage of acute myocardial infarction evolution at presentation, and incidence of thrombolysis in myocardial infarction‐3 flow after streptokinase. Am Heart J 2003; 145: 95–102. [DOI] [PubMed] [Google Scholar]
- 22. Lucchesi BR, Werns SW, Fantone JC. The role of the neutrophil and free radicals in ischemic myocardial injury. J Mol Cell Cardiol 1989; 21: 1241–1251. [DOI] [PubMed] [Google Scholar]
- 23. Mehta JL, Nichols WW, Mehta P. Neutrophils as potential participants in acute myocardial ischemia: relevance to reperfusion. J Am Coll Cardiol 1988; 11: 1309–1316. [DOI] [PubMed] [Google Scholar]
- 24. Arai M, Lefer DJ, So T, et al. An anti‐CD18 antibody limits infarct size and preserves left ventricular function in dogs with ischemia and 48‐hour reperfusion. J Am Coll Cardiol 1996; 27: 1278–1285. [DOI] [PubMed] [Google Scholar]
- 25. Palazzo AJ, Jones SP, Girod WG, et al. Myocardial ischemia‐reperfusion injury in CD18‐ and ICAM‐1‐deficient mice. Am J Physiol 1998; 275: H2300–2307. [DOI] [PubMed] [Google Scholar]
- 26. Bauersachs RM, Moessmer G, Koch C, et al. Flow resistance of individual neutrophils in coronary artery disease: decreased pore transit times in acute myocardial infarction. Heart 1997; 77: 18–23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Harlan JM, Killen PD, Harker LA, et al. Neutrophil‐mediated endothelial injury in vitro mechanisms of cell detachment. J Clin Invest 1981; 68: 1394–1403. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Ludwig PW, Hunninghake DB, Hoidal JR. Increased leucocyte oxidative metabolism in hyperlipoproteinaemia. Lancet 1982; 2: 348–350. [DOI] [PubMed] [Google Scholar]
- 29. Connelly JC, Skidgel RA, Schulz WW, et al. Neutral endopeptidase 24.11 in human neutrophils: cleavage of chemotactic peptide. Proc Natl Acad Sci USA 1985; 82: 8737–8741. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30. Takahiko N, Makiko U, Kazuo H, et al. Neutrophil infiltration of culprit lesions in acute coronary syndromes. Circulation 2002; 106: 2894–2900. [DOI] [PubMed] [Google Scholar]
