Although an association between elevated leucocyte count and mortality in patients with ACS (acute coronary syndromes) has been established, the independence of this association from coronary risk factors and C-reactive protein has been inadequately studied. In the present study, this prospective registry included 4329 patients with ACS treated with PCI (percutaneous coronary intervention): 1059 patients with STEMI [ST-segment elevation MI (myocardial infarction)], 1753 patients with NSTEMI (non-STEMI) and 1517 patients with unstable angina. Blood samples were obtained before angiography for leucocyte count and C-reactive protein measurements. The primary outcome of this analysis was 1-year mortality. At 1 year, 345 patients (8%) had died: 45 patients in the 1st tertile, 93 patients in the 2nd tertile and 207 patients in the 3rd tertile of leucocyte count [Kaplan–Meier estimates of mortality, 3.2%, 6.4% and 14.1% with an OR (odds ratio)=2.42, 95% CI (confidence interval)1.78–3.12; P<0.001 for tertile 3 compared with tertile 2 and an OR=1.99, 95% CI 1.77–2.25; P<0.001 for tertile 2 compared with tertile 1]. The Cox proportional hazards model adjusting for coronary risk factors, ACS presentation, extent of coronary artery disease, C-reactive protein and other covariates identified leucocyte count with a HR (hazard ratio)=1.05 (95% CI 1.02–1.07; P<0.001 for 1000 cells/mm3 increase in the leucocyte count), but not C-reactive protein (HR=1.13, 95% CI 0.95–1.34; P=0.15 for a 1 tertile increase in the C-reactive protein concentration) as an independent correlate of 1-year mortality. We conclude that elevated leucocyte count, but not C-reactive protein, predicts 1-year mortality independent of cardiovascular risk factors across the entire spectrum of patients with ACS treated with PCI.
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Research Article|
March 16 2009
Total leucocyte count, but not C-reactive protein, predicts 1-year mortality in patients with acute coronary syndromes treated with percutaneous coronary intervention
Gjin Ndrepepa;
*Deutsches Herzzentrum, Technische Universität, Munich, Germany
Correspondence: Dr Gjin Ndrepepa (email ndrepepa@dhm.mhn.de).
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Siegmund Braun;
Siegmund Braun
*Deutsches Herzzentrum, Technische Universität, Munich, Germany
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Raisuke Iijima;
Raisuke Iijima
*Deutsches Herzzentrum, Technische Universität, Munich, Germany
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Dritan Keta;
Dritan Keta
*Deutsches Herzzentrum, Technische Universität, Munich, Germany
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Robert A. Byrne;
Robert A. Byrne
*Deutsches Herzzentrum, Technische Universität, Munich, Germany
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Stefanie Schulz;
Stefanie Schulz
*Deutsches Herzzentrum, Technische Universität, Munich, Germany
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Julinda Mehilli;
Julinda Mehilli
*Deutsches Herzzentrum, Technische Universität, Munich, Germany
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Albert Schömig;
Albert Schömig
*Deutsches Herzzentrum, Technische Universität, Munich, Germany
†Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany
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Adnan Kastrati
Adnan Kastrati
*Deutsches Herzzentrum, Technische Universität, Munich, Germany
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Publisher: Portland Press Ltd
Received:
July 11 2008
Revision Received:
August 22 2008
Accepted:
October 14 2008
Accepted Manuscript online:
October 14 2008
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2009 Biochemical Society
2009
Clin Sci (Lond) (2009) 116 (8): 651–658.
Article history
Received:
July 11 2008
Revision Received:
August 22 2008
Accepted:
October 14 2008
Accepted Manuscript online:
October 14 2008
Citation
Gjin Ndrepepa, Siegmund Braun, Raisuke Iijima, Dritan Keta, Robert A. Byrne, Stefanie Schulz, Julinda Mehilli, Albert Schömig, Adnan Kastrati; Total leucocyte count, but not C-reactive protein, predicts 1-year mortality in patients with acute coronary syndromes treated with percutaneous coronary intervention. Clin Sci (Lond) 1 April 2009; 116 (8): 651–658. doi: https://doi.org/10.1042/CS20080298
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