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. 2006 Dec 5;29(1):36–41. doi: 10.1002/clc.4960290109

Effect of statins and white blood cell count on mortality in patients with ischemic left ventricular dysfunction undergoing percutaneous coronary intervention

Michael J Lipinski 1, Robert E Martin 1, Michael J Cowley 1, Evelyne Goudreau 1, Walter N Malloy 1, Robert E Johnson 2, George W Vetrovec 1,✉
PMCID: PMC6654517  PMID: 16477776

Abstract

Background: While morbidity and mortality were shown to be increased in the setting of an elevated white blood cell (WBC) count for patients with acute coronary syndrome, the impact of statin therapy on mortality for patients with an elevated WBC count is unknown in high‐risk patients with coronary artery disease.

Hypothesis: The goal of this study was to determine whether statin therapy improved survival in patients with elevated WBC count undergoing percutaneous coronary intervention (PCI) with preexisting left ventricular (LV) dysfunction, a population at high risk for adverse outcomes.

Methods: We retrospectively evaluated consecutive patient procedures performed at our institution from 1996 through 1999. Patients had a technically adequate angiographic left ventriculogram with a calculated ejection fraction(EF) ≤ 50%. Patients with prior coronary artery bypass graft were excluded. Mortality data were retrieved using the U.S. Social Security Death Index. Follow‐up ranged from 3.5 to 6.5 years. Means are provided with ± standard deviation, and p values <0.05 were considered significant.

Results: Of the study population of 238 patients (average EF 39 ± 9.8%, mean age 57.5 ± 12 years, 68% men) 61%un‐derwent PCI for a recent myocardial infarction, 68% received stents, and 65% were discharged on statins. Mean WBC count was 9,000 ± 3,100 cells/mm3, with 28% of patients having a WBC ≥ 10,000 cells/mm3. During follow‐up, 27% of our population died. Patients with a WBC ≥ 10,000 had worse survival than patients with WBC < 10,000 (1‐year survival: 86 vs. 96%, p<0.05; 3‐year survival: 79 vs. 89%, p<0.05). Survival was significantly improved in patients on statin therapy regardless of WBC count, but the greatest benefit tended to be in patients with WBC ≥ 10,000 (WBC ≥ 10,000; odds ratio [OR] 5.14, 95% confidence interval [CI] 1.44–19.0, WBC < 10,000; OR 2.79,95% CI 1.13–7.1). Proportional hazard regression analysis demonstrated that both statin therapy and WBC count predicted mortality.

Conclusion: Patients undergoing PCI with LV dysfunction discharged on statins had improved survival regardless of WBC count, with a trend for greater improvement in patients with elevated WBC counts. In addition, WBC count predicts mortality in this high‐risk population with LV dysfunction undergoing PCI.

Keywords: left ventricular dysfunction, statins, prognosis, coronary artery disease

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References

  • 1. Fox KF, Cowie MR, Wood DA, Coats AJ, Gibbs JS, Underwood SR, Turner RM, Poole‐Wilson PA, Davies SW, Sutton GC: Coronary artery disease as the cause of incident heart failure in the population. Eur Heart J 2001; 22: 228–236 [DOI] [PubMed] [Google Scholar]
  • 2. The Long‐Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group : Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349–1357 [DOI] [PubMed] [Google Scholar]
  • 3. Randomised trial of cholesterol lowering in 4,444 patients with coronary heart disease : The Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–1389 [PubMed] [Google Scholar]
  • 4. Sacks FM, Pfeffer MA, Moyé LA, Rouleau JL, Rutherford JD, Cole TG, Brown L, Warnica JW, Arnold JM, Wun CC, Davis BR, Braunwald E: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial Investigators. N Engl J Med 1996; 335: 1001–1009 [DOI] [PubMed] [Google Scholar]
  • 5. Kjekshus J, Pedersen TR, Olsson AG, Faergeman O, Pyorala K: The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease. J Card Fail 1997; 3: 249–254 [DOI] [PubMed] [Google Scholar]
  • 6. Hognestad A, Dickstein K, Myhre E, Snapinn S, Kjekshus J: Effect of combined statin and beta‐blocker treatment on one‐year morbidity and mortality after acute myocardial infarction associated with heart failure. Am J Cardiol 2004; 93: 603–606 [DOI] [PubMed] [Google Scholar]
  • 7. Horwich TB, MacLellan WR, Fonarow GC: Statin therapy is associated with improved survival in ischemic and non‐ischemic heart failure. J Am Coll Cardiol 2004; 43: 642–648 [DOI] [PubMed] [Google Scholar]
  • 8. Barron HV, Cannon CP, Murphy SA, Braunwald E, Gibson CM: Association between white blood cell count, epicardial blood flow, myocardial per‐fusion, and clinical outcomes in the setting of acute myocardial infarction: A Thrombolysis In Myocardial Infarction 10 substudy. Circulation 2000; 102: 2329–2334 [DOI] [PubMed] [Google Scholar]
  • 9. Menon V, Lessard D, Yarzebski J, Furman MI, Gore JM, Goldberg RJ: Leukocytosis and adverse hospital outcomes after acute myocardial infarction. Am J Cardiol 2003; 92: 368–372 [DOI] [PubMed] [Google Scholar]
  • 10. Bickel C, Rupprecht HJ, Blankenberg S, Espinola‐Klein C, Rippin G, Hafner G, Lotz J, Prellwitz W, Meyer J: Influence of HMG‐CoA reductase inhibitors on markers of coagulation, systemic inflammation and soluble celladhesion. Int J Cardiol 2002; 82: 25–31 [DOI] [PubMed] [Google Scholar]
  • 11. Kinlay S, Schwartz GG, Olsson AG, Rifai N, Leslie SJ, Sasiela WJ, Szarek M, Libby P, Ganz P: High‐dose atorvastatin enhances the decline in inflammatory markers in patients with acute coronary syndromes in the MIRACL study. Circulation 2003; 108: 1560–1566 [DOI] [PubMed] [Google Scholar]
  • 12. Chan AW, Bhatt DL, Chew DP, Reginelli J, Schneider JP, Topol EJ, Ellis SG: Relation of inflammation and benefit of statins after percutaneous coronary interventions. Circulation 2003; 107: 1750–1756 [DOI] [PubMed] [Google Scholar]
  • 13. Bickel C, Rupprecht HJ, Blankenberg S, Espiniola‐Klein C, Schlitt A, Rippin G, Hafner G, Treude R, Othman H, Hofmann KP, Meyer J: Relation of markers of inflammation (C‐reactive protein, fibrinogen, von Willebrand factor, and leukocyte count) and statin therapy to long‐term mortality in patients with angiographically proven coronary artery disease. Am J Cardiol 2002; 89: 901–908 [DOI] [PubMed] [Google Scholar]
  • 14. Su SF, Hsiao CL, Chu CW, Lee BC, Lee TM: Effects of pravastatin on left ventricular mass in patients with hyperlipidemia and essential hypertension. Am J Cardiol 2000; 86: 514–518 [DOI] [PubMed] [Google Scholar]
  • 15. Bauersachs J, Galuppo P, Fraccarollo D, Christ M, Ertl G: Improvement of left ventricular remodeling and function by hydroxymethylglutaryl coenzyme A reductase inhibition with cerivastatin in rats with heart failure after myocardial infarction. Circulation 2001; 104: 982–985 [DOI] [PubMed] [Google Scholar]
  • 16. Keelan PC, Johnston JM, Koru‐Sengul T, Detre KM, Williams DO, Slater J, Block PC, Holmes DR Jr: Comparison of in‐hospital and one‐year outcomes in patients with left ventricular ejection fractions < or = 40%, 41% to 49%, and > or = 50% having percutaneous coronary revascularization. Am J Cardiol 2003; 91: 1168–1172 [DOI] [PubMed] [Google Scholar]
  • 17. Ramires JA, Sposito AC, Mansur AP, Coelho OR, Maranhao M, Cesar LA: Cholesterol lowering with statins reduces exercise‐induced myocardial ischemia in hypercholesterolemic patients with coronary artery disease. Am J Cardiol 2001; 88: 1134–1138 [DOI] [PubMed] [Google Scholar]
  • 18. Gresser U, Gathof BS: Atorvastatin: Gold standard for prophylaxis of myocardial ischemia and stroke: Comparison of the clinical benefit of statins on the basis of randomized controlled endpoint studies. Eur J Med Res 2004; 9: 1–17 [PubMed] [Google Scholar]
  • 19. Pliquett RU, Cornish KG, Peuler JD, Zucker IH: Simvastatin normalizes autonomic neural control in experimental heart failure. Circulation 2003; 107: 2493–2498 [DOI] [PubMed] [Google Scholar]
  • 20. Nakagami H, Jensen KS, Liao JK: A novel pleiotropic effect of statins: prevention of cardiac hypertrophy by cholesterol‐independent mechanisms. Ann Med 2003; 35: 398–403 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Walter DH, Fichtlscherer S, Britten MB, Rosin P, Auch‐Schwelk W, Schachinger V, Zeiher AM: Statin therapy, inflammation and recurrent coronary events in patients following coronary stent implantation. J Am Coll Cardiol 2001; 38: 2006–2012 [DOI] [PubMed] [Google Scholar]
  • 22. Pasceri V, Patti G, Nusca A, Pristipino C, Richichi G, Di Sciascio G: Randomized trial of atorvastatin for reduction of myocardial damage during coronary intervention: Results from the ARMYDA (Atorvastatin for Reduction of MY ocardial Damage during Angioplasty) study. Circulation 2004; 110: 674–678 [DOI] [PubMed] [Google Scholar]

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