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 |
|
This article has been cited by other articles:
|
|
|
|
 
M. O'Donoghue, D. A. Morrow, C. P. Cannon, W. Guo, S. A. Murphy, C. M. Gibson, and M. S. Sabatine
Association between baseline neutrophil count, clopidogrel therapy, and clinical and angiographic outcomes in patients with ST-elevation myocardial infarction receiving fibrinolytic therapy
Eur. Heart J.,
April 2, 2008;
29(8):
984 - 991.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Asadollahi, I.M. Hastings, N.J. Beeching, and G.V. Gill
Laboratory risk factors for hospital mortality in acutely admitted patients
QJM,
August 1, 2007;
100(8):
501 - 507.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Rahimi, S. Watzlawek, H. Thiele, M.-A. Secknus, B.-F. Hayerizadeh, J. Niebauer, and G. Schuler
Incidence, time course, and predictors of early malignant ventricular arrhythmias after non-ST-segment elevation myocardial infarction in patients with early invasive treatment
Eur. Heart J.,
July 2, 2006;
27(14):
1706 - 1711.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J-C Chen, Y-J Chen, W P Chang, and D C Christiani
Long driving time is associated with haematological markers of increased cardiovascular risk in taxi drivers
Occup. Environ. Med.,
December 1, 2005;
62(12):
890 - 894.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J E Nunez, E Nunez, V Bertomeu, L Facila, J Sanchis, V Bodi, R Sanjuan, M L Blasco, A Martinez, and A Llacer
Prognostic value of baseline white blood cell count in patients with acute myocardial infarction and ST segment elevation
Heart,
August 1, 2005;
91(8):
1094 - 1095.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. D. Horne, J. L. Anderson, J. M. John, A. Weaver, T. L. Bair, K. R. Jensen, D. G. Renlund, J. B. Muhlestein, and Intermountain Heart Collaborative (IHC) Study Grou
Which White Blood Cell Subtypes Predict Increased Cardiovascular Risk?
J. Am. Coll. Cardiol.,
May 17, 2005;
45(10):
1638 - 1643.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A.H. Stewart, H. D. White, A. C. Kirby, S. R. Heritier, R. J. Simes, P. J. Nestel, M. J. West, D. M. Colquhoun, A. M. Tonkin, and for the Long-Term Intervention With Pravastatin in
White Blood Cell Count Predicts Reduction in Coronary Heart Disease Mortality With Pravastatin
Circulation,
April 12, 2005;
111(14):
1756 - 1762.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. S. Coller
Leukocytosis and Ischemic Vascular Disease Morbidity and Mortality: Is It Time to Intervene?
Arterioscler Thromb Vasc Biol,
April 1, 2005;
25(4):
658 - 670.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. M. Stuveling, S. J. L. Bakker, H. L. Hillege, P. E. de Jong, R. O. B. Gans, and D. de Zeeuw
Biochemical risk markers: a novel area for better prediction of renal risk?
Nephrol. Dial. Transplant.,
March 1, 2005;
20(3):
497 - 508.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-K. Yip, C.-L. Hang, C.-Y. Fang, Y.-K. Hsieh, C.-H. Yang, W.-C. Hung, and C.-J. Wu
Level of High-Sensitivity C-Reactive Protein Is Predictive of 30-Day Outcomes in Patients With Acute Myocardial Infarction Undergoing Primary Coronary Intervention
Chest,
March 1, 2005;
127(3):
803 - 808.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Madjid, I. Awan, J. T. Willerson, and S. W. Casscells
Leukocyte count and coronary heart disease: Implications for risk assessment
J. Am. Coll. Cardiol.,
November 16, 2004;
44(10):
1945 - 1956.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C Mueller, F-J Neumann, A P Perruchoud, and H J Buettner
White blood cell count and long term mortality after non-ST elevation acute coronary syndrome treated with very early revascularisation
Heart,
April 1, 2003;
89(4):
389 - 392.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Venerable White Blood Cell Count Predicts Mortality in MI
Journal Watch Emergency Medicine,
February 12, 2002;
2002(212):
5 - 5.
[Full Text]
|
|
|
|
|
|
|
White Blood Cell Count Predicts MI Mortality in the Elderly
Journal Watch Cardiology,
January 25, 2002;
2002(125):
5 - 5.
[Full Text]
|
|
|
|
