Impact of leukocyte count on mortality and bleeding in patients with myocardial infarction undergoing primary percutaneous coronary interventions

Analysis from the harmonizing outcome with revascularization and stent in acute myocardial infarction trial

Tullio Palmerini, Roxana Mehran, George Dangas, Eugenia Nikolsky, Bernhard Witzenbichler, Giulio Guagliumi, Darius Dudek, Philippe Genereux, Adriano Caixeta, Leroy Rabbani, Giora Weisz, Helen Parise, Martin Fahy, Ke Xu, Bruce Brodie, Alexandra Lansky, Gregg W. Stone

Research output: Contribution to journalArticle

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Abstract

Background-: The relationship between white blood cell count (WBCc) and mortality in patients with ST-segment-elevation acute myocardial infarction treated with percutaneous coronary intervention is poorly understood. Furthermore, whether there is a relationship between WBCc and risk of noncardiac mortality and bleeding after percutaneous coronary intervention is unknown. Methods and Results-: The baseline WBCc was available in 3193 of 3345 patients (95.5%) who underwent percutaneous coronary intervention in the Harmonizing Outcome With Revascularization and Stent in Acute Myocardial Infarction (HORIZONS-AMI) trial. In a propensity-adjusted multivariable analysis, WBCc was an independent predictor of 1-year cardiac mortality (hazard ratio, 1.15; 95% confidence interval, 1.09 to 1.22), noncardiac mortality (hazard ratio, 1.19; 95% confidence interval, 1.10 to 1.29), and major bleeding (hazard ratio, 1.08; 95% confidence interval, 1.04 to 1.12). After adjustment for baseline creatinine phosphokinase levels and left ventricular ejection fraction, WBCc remained an independent predictor of 1-year all-cause mortality and cardiac mortality. In patients matched for baseline creatinine phosphokinase levels at hospital admission, the median peak creatinine phosphokinase level was significantly higher in patients with high WBCc (>11 000 per 1 mm) compared with low WBCc (1851 U/L [range, 880-3307 U/L] versus 1241 U/L [range, 540 to 2,78], respectively; P<0.0001). In this subgroup of patients, WBCc was an independent correlate of peak creatinine phosphokinase level, and remained an independent predictor of 1-year mortality. Conclusions-: In patients with ST-segment-elevation acute myocardial infarction undergoing percutaneous coronary intervention, elevated baseline WBCc is an independent predictor of infarct size, as assessed by peak creatinine phosphokinase level, and of 1-year cardiac mortality, noncardiac mortality, and major bleeding.

Original languageEnglish (US)
Pages (from-to)2829-2837
Number of pages9
JournalCirculation
Volume123
Issue number24
DOIs
StatePublished - Jun 21 2011

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Percutaneous Coronary Intervention
Leukocyte Count
Stents
Myocardial Infarction
Hemorrhage
Mortality
Creatinine
Phosphotransferases
Confidence Intervals
Stroke Volume

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Palmerini, Tullio ; Mehran, Roxana ; Dangas, George ; Nikolsky, Eugenia ; Witzenbichler, Bernhard ; Guagliumi, Giulio ; Dudek, Darius ; Genereux, Philippe ; Caixeta, Adriano ; Rabbani, Leroy ; Weisz, Giora ; Parise, Helen ; Fahy, Martin ; Xu, Ke ; Brodie, Bruce ; Lansky, Alexandra ; Stone, Gregg W. / Impact of leukocyte count on mortality and bleeding in patients with myocardial infarction undergoing primary percutaneous coronary interventions : Analysis from the harmonizing outcome with revascularization and stent in acute myocardial infarction trial. In: Circulation. 2011 ; Vol. 123, No. 24. pp. 2829-2837.
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title = "Impact of leukocyte count on mortality and bleeding in patients with myocardial infarction undergoing primary percutaneous coronary interventions: Analysis from the harmonizing outcome with revascularization and stent in acute myocardial infarction trial",
abstract = "Background-: The relationship between white blood cell count (WBCc) and mortality in patients with ST-segment-elevation acute myocardial infarction treated with percutaneous coronary intervention is poorly understood. Furthermore, whether there is a relationship between WBCc and risk of noncardiac mortality and bleeding after percutaneous coronary intervention is unknown. Methods and Results-: The baseline WBCc was available in 3193 of 3345 patients (95.5{\%}) who underwent percutaneous coronary intervention in the Harmonizing Outcome With Revascularization and Stent in Acute Myocardial Infarction (HORIZONS-AMI) trial. In a propensity-adjusted multivariable analysis, WBCc was an independent predictor of 1-year cardiac mortality (hazard ratio, 1.15; 95{\%} confidence interval, 1.09 to 1.22), noncardiac mortality (hazard ratio, 1.19; 95{\%} confidence interval, 1.10 to 1.29), and major bleeding (hazard ratio, 1.08; 95{\%} confidence interval, 1.04 to 1.12). After adjustment for baseline creatinine phosphokinase levels and left ventricular ejection fraction, WBCc remained an independent predictor of 1-year all-cause mortality and cardiac mortality. In patients matched for baseline creatinine phosphokinase levels at hospital admission, the median peak creatinine phosphokinase level was significantly higher in patients with high WBCc (>11 000 per 1 mm) compared with low WBCc (1851 U/L [range, 880-3307 U/L] versus 1241 U/L [range, 540 to 2,78], respectively; P<0.0001). In this subgroup of patients, WBCc was an independent correlate of peak creatinine phosphokinase level, and remained an independent predictor of 1-year mortality. Conclusions-: In patients with ST-segment-elevation acute myocardial infarction undergoing percutaneous coronary intervention, elevated baseline WBCc is an independent predictor of infarct size, as assessed by peak creatinine phosphokinase level, and of 1-year cardiac mortality, noncardiac mortality, and major bleeding.",
author = "Tullio Palmerini and Roxana Mehran and George Dangas and Eugenia Nikolsky and Bernhard Witzenbichler and Giulio Guagliumi and Darius Dudek and Philippe Genereux and Adriano Caixeta and Leroy Rabbani and Giora Weisz and Helen Parise and Martin Fahy and Ke Xu and Bruce Brodie and Alexandra Lansky and Stone, {Gregg W.}",
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Palmerini, T, Mehran, R, Dangas, G, Nikolsky, E, Witzenbichler, B, Guagliumi, G, Dudek, D, Genereux, P, Caixeta, A, Rabbani, L, Weisz, G, Parise, H, Fahy, M, Xu, K, Brodie, B, Lansky, A & Stone, GW 2011, 'Impact of leukocyte count on mortality and bleeding in patients with myocardial infarction undergoing primary percutaneous coronary interventions: Analysis from the harmonizing outcome with revascularization and stent in acute myocardial infarction trial', Circulation, vol. 123, no. 24, pp. 2829-2837. https://doi.org/10.1161/CIRCULATIONAHA.110.985564

Impact of leukocyte count on mortality and bleeding in patients with myocardial infarction undergoing primary percutaneous coronary interventions : Analysis from the harmonizing outcome with revascularization and stent in acute myocardial infarction trial. / Palmerini, Tullio; Mehran, Roxana; Dangas, George; Nikolsky, Eugenia; Witzenbichler, Bernhard; Guagliumi, Giulio; Dudek, Darius; Genereux, Philippe; Caixeta, Adriano; Rabbani, Leroy; Weisz, Giora; Parise, Helen; Fahy, Martin; Xu, Ke; Brodie, Bruce; Lansky, Alexandra; Stone, Gregg W.

In: Circulation, Vol. 123, No. 24, 21.06.2011, p. 2829-2837.

Research output: Contribution to journalArticle

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T1 - Impact of leukocyte count on mortality and bleeding in patients with myocardial infarction undergoing primary percutaneous coronary interventions

T2 - Analysis from the harmonizing outcome with revascularization and stent in acute myocardial infarction trial

AU - Palmerini, Tullio

AU - Mehran, Roxana

AU - Dangas, George

AU - Nikolsky, Eugenia

AU - Witzenbichler, Bernhard

AU - Guagliumi, Giulio

AU - Dudek, Darius

AU - Genereux, Philippe

AU - Caixeta, Adriano

AU - Rabbani, Leroy

AU - Weisz, Giora

AU - Parise, Helen

AU - Fahy, Martin

AU - Xu, Ke

AU - Brodie, Bruce

AU - Lansky, Alexandra

AU - Stone, Gregg W.

PY - 2011/6/21

Y1 - 2011/6/21

N2 - Background-: The relationship between white blood cell count (WBCc) and mortality in patients with ST-segment-elevation acute myocardial infarction treated with percutaneous coronary intervention is poorly understood. Furthermore, whether there is a relationship between WBCc and risk of noncardiac mortality and bleeding after percutaneous coronary intervention is unknown. Methods and Results-: The baseline WBCc was available in 3193 of 3345 patients (95.5%) who underwent percutaneous coronary intervention in the Harmonizing Outcome With Revascularization and Stent in Acute Myocardial Infarction (HORIZONS-AMI) trial. In a propensity-adjusted multivariable analysis, WBCc was an independent predictor of 1-year cardiac mortality (hazard ratio, 1.15; 95% confidence interval, 1.09 to 1.22), noncardiac mortality (hazard ratio, 1.19; 95% confidence interval, 1.10 to 1.29), and major bleeding (hazard ratio, 1.08; 95% confidence interval, 1.04 to 1.12). After adjustment for baseline creatinine phosphokinase levels and left ventricular ejection fraction, WBCc remained an independent predictor of 1-year all-cause mortality and cardiac mortality. In patients matched for baseline creatinine phosphokinase levels at hospital admission, the median peak creatinine phosphokinase level was significantly higher in patients with high WBCc (>11 000 per 1 mm) compared with low WBCc (1851 U/L [range, 880-3307 U/L] versus 1241 U/L [range, 540 to 2,78], respectively; P<0.0001). In this subgroup of patients, WBCc was an independent correlate of peak creatinine phosphokinase level, and remained an independent predictor of 1-year mortality. Conclusions-: In patients with ST-segment-elevation acute myocardial infarction undergoing percutaneous coronary intervention, elevated baseline WBCc is an independent predictor of infarct size, as assessed by peak creatinine phosphokinase level, and of 1-year cardiac mortality, noncardiac mortality, and major bleeding.

AB - Background-: The relationship between white blood cell count (WBCc) and mortality in patients with ST-segment-elevation acute myocardial infarction treated with percutaneous coronary intervention is poorly understood. Furthermore, whether there is a relationship between WBCc and risk of noncardiac mortality and bleeding after percutaneous coronary intervention is unknown. Methods and Results-: The baseline WBCc was available in 3193 of 3345 patients (95.5%) who underwent percutaneous coronary intervention in the Harmonizing Outcome With Revascularization and Stent in Acute Myocardial Infarction (HORIZONS-AMI) trial. In a propensity-adjusted multivariable analysis, WBCc was an independent predictor of 1-year cardiac mortality (hazard ratio, 1.15; 95% confidence interval, 1.09 to 1.22), noncardiac mortality (hazard ratio, 1.19; 95% confidence interval, 1.10 to 1.29), and major bleeding (hazard ratio, 1.08; 95% confidence interval, 1.04 to 1.12). After adjustment for baseline creatinine phosphokinase levels and left ventricular ejection fraction, WBCc remained an independent predictor of 1-year all-cause mortality and cardiac mortality. In patients matched for baseline creatinine phosphokinase levels at hospital admission, the median peak creatinine phosphokinase level was significantly higher in patients with high WBCc (>11 000 per 1 mm) compared with low WBCc (1851 U/L [range, 880-3307 U/L] versus 1241 U/L [range, 540 to 2,78], respectively; P<0.0001). In this subgroup of patients, WBCc was an independent correlate of peak creatinine phosphokinase level, and remained an independent predictor of 1-year mortality. Conclusions-: In patients with ST-segment-elevation acute myocardial infarction undergoing percutaneous coronary intervention, elevated baseline WBCc is an independent predictor of infarct size, as assessed by peak creatinine phosphokinase level, and of 1-year cardiac mortality, noncardiac mortality, and major bleeding.

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