Although inflammation is involved in the pathogenesis of acute coronary syndromes,
the extent of inflammation is not routinely assessed, and its prognostic implications
in patients with non–ST-segment elevation acute coronary syndrome have not been investigated
in depth. We analyzed the prognostic implications of an elevated white blood cell
count (WBCc) in patients with moderate and high-risk non–ST-segment elevation acute
coronary syndrome undergoing an early invasive strategy in the large-scale Acute Catheterization
and Urgent Intervention Triage StrategY trial. The WBCc at admission was available
for 13,678 of 13,819 patients (98.9%). The patients in the upper tertile of the WBCc
had an increased risk of 30-day major bleeding, 1-year mortality, and definite/probable
stent thrombosis compared to those in the mid or lower tertiles. On multivariate analysis,
the WBCc was an independent predictor of 30-day major bleeding and 1-year cardiac,
noncardiac, and all-cause mortality. The association between the WBCc and cardiac
mortality was present in multiple prespecified subgroups, with no significant interaction
between the WBCc and age, gender, diabetes, smoking, renal dysfunction, elevated baseline
biomarkers, antithrombotic therapy, revascularization, and Thrombolysis In Myocardial
Infarction risk score. The WBCc remained an independent predictor of mortality after
adjusting for bleeding, C-reactive protein level, and angiographic variables, including
left ventricular ejection fraction, Thrombolysis In Myocardial Infarction flow, and
number of diseased vessels. The WBCc significantly improved the prognostic accuracy
of the Thrombolysis In Myocardial Infarction risk score, with a net reclassification
improvement of 11% (p <0.0001). In conclusion, in patients with moderate- and high-risk
non–ST-segment elevation acute coronary syndrome, an elevated admission WBCc was an
independent predictor of 30-day major bleeding, and 1-year cardiac, noncardiac, and
all-cause mortality.
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Article info
Publication history
Published online: February 13, 2013
Accepted:
December 26,
2012
Received in revised form:
December 26,
2012
Received:
October 31,
2012
Footnotes
The ACUITY trial was funded by The Medicines Company, (Parsippany, New Jersey), and Nycomed (Roskilde, Denmark).
See page 1244 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
