An Increased Monocyte Count Predicts Coronary Artery Spasm in Patients with Resting Chest Pain and Insignificant Coronary Artery Stenosis

Abstract

BackgroundCoronary atherosclerosis with inflammation gives rise to coronary vasospasm in the patients with coronary vasospastic angina. We have postulated that the peripheral leukocyte count and the differential count are associated with vasospastic angina.Methods144 patients who underwent intracoronary ergonovine provocation testing between January 2002 and December 2004 were divided into two groups: Group I (72 patients with provoked spasm, mean age: 54.8±10.7 years, males: 75%) and Group II (72 without spasm, mean age: 55.3±10.2 years, males: 35%). Blood sampling was done to measure the lipid profiles and inflammatory markers, including the high sensitive C-reactive protein (hsCRP) levels and the monocyte counts. We compared the angiographic findings and laboratory data between the two groups.ResultsThere were no significant differences in the levels of serum lipid and hsCRP between the two groups. The white blood cell count and the monocyte count were higher in Group I than with Group II (7496.4±2622.28 vs. 6703.2±1768.37/mm3, respectively, p=0.035; 627.5±270.70 vs. 426.9±205.76/mm3, respectively, p<0.001). Gensini's score was higher in Group I than in Group II (2.2±2.88 vs. 0.5±1.03, respectively, p<0.001). Multivariate analysis showed that the monocyte count and Gensini's score were independent factors affecting coronary spasm (p=0.047 and p=0.018, respectively). According to a receiver operating characteristics curve analysis, the area under the curve of the monocyte count was 0.738, that of the neutrophil count was 0.577 and that of the WBC count was 0.572. The cut-off value of the monocyte count was 530/mm3; the sensitivity and specificity of this cut-off value were 64% and 76%, respectively.ConclusionsThe peripheral monocyte count is an independent marker for predicting vasospastic angina in the patients with resting chest pain and insignificant coronary artery stenosis.

Author's Response to the Letter to the Editor

“…I do agree that there should be more detailed characterization of this association. Others have found that the peripheral monocyte count is an independent marker for predicting vasospastic angina in the patients with resting chest pain and insignificant coronary artery stenosis . The results published by Beyan et al, and De Luca et al were totally opposite from our results …”

Plasma sE-Selectin Level Is Positively Correlated with Neutrophil Count and Diastolic Blood Pressure in Japanese Men

“…Previous studies have demonstrated that monocyte count is also positively associated with CVD in Western and Asian people (23,24). However, many studies have demonstrated that neutrophil count rather than monocyte count is positively associated with development of CVD in Western and Asian countries (10,13,25,26).…”

The Association Between Complete Blood Count and the Risk of Coronary Heart Disease

“…Of 16 studies, five studies were compatible for metaanalysis with a total of 889 CHD patients and 4306 controls (Table 3). 22,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Mean (±SD) We found that elevated leukocyte had a significant association with the incidence of CHD (OR 95%CI=3.57 [1.84-6.93], p<0.001) ( Table 3, Figure 2 A).…”

“…For the association between eosinophil and CHD, eight studies were identified; four retrospective studies, three cross sectional studies and one cohort study. 30,[38][39][40][43][44][45][46] Of these, five studies and our results with a total 513 CHD patients and 3998 controls were included in our meta-analysis. 30,[38][39][40]43 The results found that elevated eosinophil count had the significant association with the risk of CHD (OR 95%CI = 5.34 [1.17-24.77], p=0.031) ( Table 3, Figure 2 B).…”