Admission Leukocyte Count is Associated with Late Cardiogenic Shock Development and All-Cause 30-Day Mortality in Patients with St-Elevation Myocardial Infarction

Abstract

Background: Thirty-day mortality in ST-elevation myocardial infarction (STEMI) patients is primarily driven by cardiogenic shock (CS). High neutrophil counts and high neutrophil/lymphocyte ratios (NLR) have previously been associated with mortality in STEMI patients; however, there is only sparse knowledge regarding their association with CS. Purpose: We sought to assess the associations between neutrophil count and NLR with the development of CS as well as 30-day mortality in STEMI patients. Methods: Patients admitted with STEMI at two tertiary Heart Centres throughout 1 year were included in the study and stratified into quartiles according to the level of leukocyte count upon admission. The primary endpoint was development of CS both before (early CS) and after leaving the catheterization laboratory (late CS). The secondary endpoint was all-cause 30-day mortality. Results: A total of 1,892 STEMI patients were included, whereof 194 (10%) developed CS while 122 (6.4%) died within 30 days. Patients in the highest quartile of neutrophils (OR: 2.54; 95% CI: 1.40–4.60; P = 0.002) and NLR (OR: 3.64; 95% CI: 2.02–6.54; P<0.0001) were at increased risk of developing late CS compared with patients in the lower quartiles, whereas there was no risk difference across quartiles regarding development of early CS. Both biomarkers correlated strongly to an increased 30-day mortality (plogrank<0.0001) and, moreover, a high level of neutrophils was independently associated with 30-day mortality (HR: 1.95; 95% CI: 1.25–3.03; P = 0.003). Conclusion: High levels of neutrophils and a high NLR upon admission for STEMI were independently associated with an increased risk of developing late CS and, additionally, both biomarkers showed association to 30-day mortality.

Leukocyte and its Subtypes as Predictors of Short-Term Outcome in Cardiogenic Shock Complicating Acute Myocardial Infarction: A Cohort Study

“…Indeed, the elevation extent of leukocyte after AMI has been shown to correlate with the infarct size (20) and also the prognosis in patients with AMI. Our present study demonstrated elevated leukocyte was an independent risk factor for 30-day all-cause mortality, consistent with previous studies (21), indicating its prognostic importance in patients with CS complicating AMI.…”

C-Reactive Protein and White Blood Cell Count in Cardiogenic Shock

“…According to Barron et al, high WBC counts were associated with an increased risk of 30-day all-cause mortality in 975 patients with AMI [25]. In line, WBC count was associated with higher rates of 30-day all-cause mortality, including 1892 patients with STEMI [17]. Ohlmann et al showed an association between elevated CRP levels on admission and longterm mortality in patients after primary percutaneous interventions (PCI) in STEMI [26], which is in line with further studies [27,28].…”

“…Elevated WBC counts are generally related to increased mortality in cardiovascular diseases, pursuant to several studies [15,16]. With regard to AMI patients, Klein et al demonstrated that 30-day mortality rates were significantly higher in patients within the highest WBC quartiles, including 1892 patients with an ST-elevation myocardial infarction (STEMI) [17].…”

Usefulness of Immature Granulocytes as A Prognostic Factor in ST-Elevation Myocardial Infarction

“…WBC, neutrophil counts, etc.) and the ratios of such parameters to each other have been reported to have a prognostic value in patients with coronary artery disease and STEMI [ 16 - 19 ] . The present study has shown an association between the IG count, a simple haemogram parameter, and poor prognosis in STEMI patients.…”