Advertisement

Effect of both elevated troponin-I and peripheral white blood cell count on prognosis in patients with suspected myocardial injury

      We found a high white blood cell count (>11,000/μl) to be of additive prognostic value to high troponin-I levels in predicting risk of recurrent nonfatal myocardial infarctions and all-cause mortality in patients who present with acute coronary syndromes and non–ST-elevation myocardial infarctions. A high troponin-I level or white blood cell count increased the odds ratio of an event to 2.2 (95% confidence interval 1.0 to 4.73, p = 0.05), but high values for the 2 markers increased the odds ratio to 4.5 (95% confidence interval 1.42 to 14.21, p = 0.01).
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dominitz J.A.
        • Maynard C.
        • Boyko E.J.
        Assessment of vital status in Department of Veterans Affairs national databases.
        Ann Epidemiol. 2001; 11: 286-291
      1. American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes: a report of the American College of Cardiology task force on clinical data standards (acute coronary syndromes writing committee).
        J Am Coll Cardiol. 2001; 38: 2114-2130
        • Yen M.
        • Bhatt D.
        • Chew D.
        • Harrington R.A.
        • Newby L.K.
        • Ardissino D.
        • Van de Werf F.
        • White J.A.
        • Moliterno D.S.
        • Topol E.J.
        Association between admission white blood cell count and one-year mortality in patients with acute coronary syndromes.
        Am J Med. 2003; 115: 318-321
        • Bhatt D.L.
        • Chew D.P.
        • Lincoff A.M.
        • Simoons M.L.
        • Harrington R.A.
        • Ommen S.R.
        • Jia G.
        • Topol E.J.
        • PURSUIT Investigators
        Effect of revascularization on mortality associated with an elevated white blood cell count in acute coronary syndromes.
        Am J Cardiol. 2003; 92: 136-140
        • Mueller C.
        • Neumann F.J.
        • Perruchoud A.P.
        • Buettner H.J.
        White blood cell count and long term mortality after non-ST elevation acute coronary syndrome treated with very early revascularisation.
        Heart. 2003; 89: 389-392
        • Sabatine M.S.
        • Morrow D.A.
        • Cannon C.P.
        • Murphy S.A.
        • Demopoulos L.A.
        • DiBattiste P.M.
        • McCabe C.H.
        • Braunwald E.
        • Gibson C.M.
        Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI substudy.
        J Am Coll Cardiol. 2002; 40: 1761-1768
        • Cannon C.P.
        • McCabe C.H.
        • Wilcox R.G.
        • Bentley J.H.
        • Braunwald E.
        Association of white blood cell count with increased mortality in acute myocardial infarction and unstable angina pectoris.
        Am J Cardiol. 2001; 87: 636-639
        • Buffon A.
        • Biasucci L.M.
        • Liuzzo G.
        • D'Onofrio G.
        • Crea F.
        • Maseri A.
        Widespread coronary inflammation in unstable angina.
        N Engl J Med. 2002; 347: 5-12
        • Celi A.
        • Pellegrini G.
        • Lorenzet R.
        • De Blasi A.
        • Ready N.
        • Furie B.C.
        • Furie B.
        P-selectin induces the expression of tissue factor on monocytes.
        Proc Natl Acad Sci USA. 1994; 91: 8767-8771
        • Cermak J.
        • Key N.S.
        • Bach R.R.
        • Balla J.
        • Jacob H.S.
        • Vercellotti G.M.
        C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor.
        Blood. 1993; 82: 513-520
        • Engler R.L.
        • Schmid-Schonbein G.W.
        • Pavelec R.S.
        Leukocyte capillary plugging in myocardial ischemia and reperfusion in the dog.
        Am J Pathol. 1983; 111: 98-111
        • Meisel S.R.
        • Shapiro H.
        • Radnay J.
        • Neuman Y.
        • Khaskia A.R.
        • Gruener N.
        • Pauzner H.
        • David D.
        Increased expression of neutrophil and monocyte adhesion molecules LFA-1 and Mac-1 and their ligand ICAM-1 and VLA-4 throughout the acute phase of myocardial infarction: possible implications for leukocyte aggregation and microvascular plugging.
        J Am Coll Cardiol. 1998; 31: 120-125
        • Barron H.V.
        • Cannon C.P.
        • Murphy S.A.
        • Braunwald E.
        • Gibson C.M.
        Association between white blood cell count, epicardial blood flow, myocardial perfusion, and clinical outcomes in the setting of acute myocardial infarction: a thrombolysis in myocardial infarction 10 substudy.
        Circulation. 2000; 102: 2329-2334
        • Furman M.I.
        • Barnard M.R.
        • Krueger L.A.
        • Fox M.L.
        • Shilale E.A.
        • Lessard D.M.
        • Marchese P.
        • Frelinger III, A.L.
        • Goldberg R.J.
        • Michelson A.D.
        Circulating monocyte-platelet aggregates are an early marker of acute myocardial infarction.
        J Am Coll Cardiol. 2001; 38: 1002-1006