Author/Authors :
Appendix، نويسنده , , Mark I. Furman MD، نويسنده , , Joel M. Gore، نويسنده , , Fredrick A. Anderson، نويسنده , , Andrzej Budaj، نويسنده , , Shaun G. Goodman، نويسنده , , ?varo Avezum، نويسنده , , Jose Lopez-Sendon، نويسنده , , Werner Klein MD FESC، نويسنده , , Debabrata Mukherjee، نويسنده , , Kim A. Eagle، نويسنده , , Omar H. Dabbous، نويسنده , , Robert J. Goldberg PhD، نويسنده , , GRACE Investigators، نويسنده ,
Abstract :
Objective
To examine the association between elevated leukocyte count and hospital mortality and heart failure in patients enrolled in the multinational, observational Global Registry of Acute Coronary Events (GRACE).
Background
Elevated leukocyte count is associated with adverse hospital outcomes in patients presenting with acute myocardial infarction (AMI). The association of this prognostic factor with hospital mortality and heart failure in patients with other acute coronary syndromes (ACS) is unclear.
Methods
We examined the association between admission leukocyte count and hospital mortality and heart failure in 8269 patients presenting with an ACS. This association was examined separately in patients with ST-segment elevation AMI, non-ST–segment elevation AMI, and unstable angina. Leukocyte count was divided into 4 mutually exclusive groups (Q): Q1 <6000, Q2 = 6000–9999, Q3 = 10,000–11,999, Q4 >12,000. Multiple logistic regression analysis was performed to examine the association between elevated leukocyte count and hospital events while accounting for the simultaneous effect of several potentially confounding variables.
Results
Increasing leukocyte count was significantly associated with hospital death (adjusted odds ratio [OR] 2.8, 95% CI 2.1–3.6 for Q4 compared to Q2 [normal range]) and heart failure (OR 2.7, 95% CI 2.2–3.4) for patients presenting with ACS. This association was seen in patients with ST-segment elevation AMI (OR for hospital death 3.2, 95% CI 2.1–4.7; OR for heart failure 2.4, 95% CI 1.8–3.3), non-ST–segment elevation AMI (OR for hospital death 1.9, 95% CI 1.2–3.0; OR for heart failure 1.7, 95% CI 1.1–2.5), or unstable angina (OR for hospital death 2.8, 95% CI 1.4–5.5; OR for heart failure 2.0, 95% CI 0.9–4.4).
Conclusion
In men and women of all ages with the spectrum of ACS, initial leukocyte count is an independent predictor of hospital death and the development of heart failure.
