Leukocytosis as The Short-Term Predictor for Mortality in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Setyasih Anjarwani, Krishna Ari Nugraha, Muhammad Rizki Fadlan



Background: In daily clinical practice, leukocyte count is the most common and simple inflammation parameter. Moreover, its role in predicting acute coronary syndrome (ACS) patients' clinical outcomes and prognosis is still conflicting. This study aimed to assess the role of leukocytosis as the predictor of mortality in ACS patients undergoing percutaneous coronary intervention (PCI).

Method: This single-center retrospective cohort study used the STEMI registry data in Saiful Anwar General Hospital, Malang, Indonesia, from January to July 2019. The exposure was the leucocyte count during hospital admission and the outcome was the 30-day mortality following PCI procedure. The receiver-operating characteristic (ROC) curve was used to determine leucocyte count cut-off pint, sensitivity, and specificity.

Result: The best leukocyte count cut-off value was 12300/µL, with the area under the curve (AUC) of 0.702 (95% CI 0.575 - 0.83), sensitivity of 71.4%, and specificity of 61.3%. Leukocytosis increased the risk of 30-day mortality (74.5% vs 42.4%; OR = 3.958; 95% CI = 1.518-10.25; p = 0.014). Survival rate within 30-day after PCI was lowered in leukocytosis group (the Log-Rank p = 0.002). The difference became apparent after day five post-PCI. 

Conclusion: Leukocytosis during hospital admission is associated with increased mortality in ACS patients undergoing PCI. Leucocytosis is a good predictor of mortality within 30 days after PCI in this population.


Keywords: leukocytosis, acute coronary syndrome, percutaneous coronary intervention, mortality


leukocytosis, acute coronary syndrome, percutaneous coronary intervention, mortality

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Palmerini T, Mehran R, Dangas G, et al. 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. 2011;123(24):2829-2837. doi:10.1161/CIRCULATIONAHA.110.985564

Yeh Y-T, Liu C-W, Li A-H, et al. Rapid Early Triage by Leukocytosis and the Thrombolysis in Myocardial Infarction (TIMI) Risk Score for ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: An Observational Study. Medicine (Baltimore). 2016;95(7):e2857. doi:10.1097/MD.0000000000002857

Davies MJ. CORONARY DISEASE: The pathophysiology of acute coronary syndromes. Heart. 2000;83(3):361-366. doi:10.1136/heart.83.3.361

Crea F, Libby P. Acute Coronary Syndromes: The Way Forward From Mechanisms to Precision Treatment. Circulation. 2017;136(12):1155-1166. doi:10.1161/CIRCULATIONAHA.117.029870

Libby P, Ridker PM, Maseri A. Inflammation and Atherosclerosis. Circulation. 2002;105(9):1135-1143. doi:10.1161/hc0902.104353

O’Brien KD, Chait A. Serum amyloid A: The “other” inflammatory protein. Curr Atheroscler Rep. 2006;8(1):62-68. doi:10.1007/s11883-006-0066-0

Shishehbor MH, Hazen SL. Inflammatory and oxidative markers in atherosclerosis: Relationship to outcome. Curr Atheroscler Rep. 2004;6(3):243-250. doi:10.1007/s11883-004-0038-1

Núñez J, Fácila L, Llàcer À, et al. Prognostic Value of White Blood Cell Count in Acute Myocardial Infarction: Long-Term Mortality. Rev Esp Cardiol Engl Ed. 2005;58(6):631-639. doi:10.1016/S1885-5857(06)60249-1

Jan AF, Habib S, Naseeb K, Khatri MA, Zaman KS. High Total Leukocyte Count and Heart Failure After Myocardial Infarction. Pak Heart J. 2011;44(1):10.

Ferrari JP, Lueneberg ME, Silva RL da, Fattah T, Gottschall CAM, Moreira DM. Correlation between leukocyte count and infarct size in ST segment elevation myocardial infarction. Arch Med Sci - Atheroscler Dis. 2016;1:44-48. doi:10.5114/amsad.2016.60759

Antman EM, Cohen M. The TIMI Risk Score for Unstable Angina/Non–ST Elevation MI. JAMA. 284(7):835-842. doi:10.1001/jama.284.7.835

Fox KAA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333(7578):1091-1094. doi:10.1136/bmj.38985.646481.55

Fox KAA, FitzGerald G, Puymirat E, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014;4(2):e004425. doi:10.1136/bmjopen-2013-004425

Cannon CP, McCabe CH, Wilcox RG, Bentley JH, Braunwald E. Association of white blood cell count with increased mortality in acute myocardial infarction and unstable angina pectoris. Am J Cardiol. 2001;87(5):636-639. doi:10.1016/S0002-9149(00)01444-2

Barron HV, Harr SD, Radford MJ, Wang Y, Krumholz HM. The association between white blood cell count and acute myocardial infarction mortality in patients ≥65 years of age: findings from the cooperative cardiovascular project. J Am Coll Cardiol. 2001;38(6):1654-1661. doi:10.1016/S0735-1097(01)01613-8

Dharma S, Hapsari R, Siswanto B, van der Laarse A, Jukema J. Blood Leukocyte Count on Admission Predicts Cardiovascular Events in Patients with Acute Non-ST Elevation Myocardial Infarction. Int J Angiol. 2015;24(02):127-132. doi:10.1055/s-0035-1544178

Dragu R, Huri S, Zukermann R, et al. Predictive value of white blood cell subtypes for long-term outcome following myocardial infarction. Atherosclerosis. 2008;196(1):405-412. doi:10.1016/j.atherosclerosis.2006.11.022

Furman MI, Gore JM, Anderson FA, et al. Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2004;147(1):42-48. doi:10.1016/j.ahj.2003.07.003

Park JJ, Jang H-J, Oh I-Y, et al. Prognostic Value of Neutrophil to Lymphocyte Ratio in Patients Presenting With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Am J Cardiol. 2013;111(5):636-642. doi:10.1016/j.amjcard.2012.11.012

Çiçek G, Açıkgöz SK, Yayla Ç, Kundi H, İleri M. White blood cell count to mean platelet volume ratio: A novel and promising prognostic marker for ST-segment elevation myocardial infarction. Cardiol J. 2016;23(3):11. doi:10.5603/CJ.a2016.0001

Madjid M, Awan I, Willerson JT, Casscells SW. Leukocyte count and coronary heart disease. J Am Coll Cardiol. 2004;44(10):1945-1956. doi:10.1016/j.jacc.2004.07.056

Ren F, Mu N, Zhang X, et al. Increased Platelet-leukocyte Aggregates Are Associated With Myocardial No-reflow in Patients With ST Elevation Myocardial Infarction. Am J Med Sci. 2016;352(3):261-266. doi:10.1016/j.amjms.2016.05.034

Swystun LL, Liaw PC. The role of leukocytes in thrombosis. Blood. 2016;128(6):753-762. doi:10.1182/blood-2016-05-718114

Neumann F-J, Ott I, Marx N, et al. Effect of Human Recombinant Interleukin-6 and Interleukin-8 on Monocyte Procoagulant Activity. Arterioscler Thromb Vasc Biol. 1997;17(12):3399-3405. doi:10.1161/01.ATV.17.12.3399

Montero S, Bayes-Genis A. The overlooked tsunami of systemic inflammation in post-myocardial infarction cardiogenic shock. Eur J Prev Cardiol. Published online 2020. doi:10.1093/eurjpc/zwaa013

Iborra-Egea O, Rueda F, García-García C, Borràs E, Sabidó E, Bayes-Genis A. Molecular signature of cardiogenic shock. Eur Heart J. 2020;41(39):3839-3848. doi:10.1093/eurheartj/ehz783

Thiele H, Ohman EM, de Waha-Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: an update 2019. Eur Heart J. 2019;40(32):2671-2683. doi:10.1093/eurheartj/ehz363

Vahdatpour C, Collins D, Goldberg S. Cardiogenic Shock. J Am Heart Assoc. 2019;8(8). doi:10.1161/JAHA.119.011991

DOI: https://doi.org/10.21776/ub.hsj.2020.001.04.04


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