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CLINICAL STUDY

The association between white blood cell count and acute myocardial infarction mortality in patients 65 years of age: findings from the cooperative cardiovascular project

Hal V. Barron, MD, FACC^* , Steven D. Harr, MD^*, Martha J. Radford, MD, FACC ^||, Yongfei Wang, MS and Harlan M. Krumholz, MD, FACC^{*, || ¶}

^* Department of Epidemiology and Biostatistics and Medicine (Cardiology), University of California, San Francisco, San Francisco, California, USA
Department of Medical Affairs, Genentech Inc., South San Francisco, California, USA
Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
^|| Qualidigm, Middletown, Connecticut, USA
^¶ Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA

Manuscript received March 2, 2001; revised manuscript received July 16, 2001, accepted August 15, 2001.

^* Reprint requests and correspondence: Dr. Harlan M. Krumholz, 333 Cedar Street, P.O. Box 208025, New Haven, Connecticut 06520-8025 USA

OBJECTIVES

The purpose of the study was to examine the association between white blood cell (WBC) count on admission and 30-day mortality in patients with acute myocardial infarction (AMI).

BACKGROUND

Elevations in WBC count have been associated with the development of AMI and with long-term mortality in patients with coronary artery disease. However, the relationship between WBC count and prognosis following AMI is less clear.

METHODS

Using the Cooperative Cardiovascular Project database, we evaluated 153,213 patients 65 years of age admitted with AMI.

RESULTS

An increasing WBC count is associated with a significantly higher risk of in-hospital events, in-hospital mortality and 30-day mortality. Relative to those patients in the lowest quintile, patients in the highest quintile were three times more likely to die at 30 days (10.3% vs. 32.3%; p < 0.001). After adjustment for confounding factors, WBC count was found to be a strong independent predictor of 30-day mortality (odds ratio = 2.37; 95% confidence interval 2.25 to 2.49, p = 0.0001 for the highest quintile of WBC count).

CONCLUSIONS

White blood cell count within 24 h of admission for an AMI is a strong and independent predictor of in-hospital and 30-day mortality as well as in-hospital clinical events. Although the mechanism of the association remains speculative, the results of this study have important clinical implications for risk-stratifying patients with AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CCP = Cooperative Cardiovascular Project   CI = confidence interval   CK = creatine phosphokinase   ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification   OR = odds ratio   TIMI = Thrombolysis In Myocardial Infarction   WBC = white blood cell

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