Association of white blood cell count with increased mortality in acute myocardial infarction and unstable angina pectoris

Cannon, Christopher P.; McCabe, Carolyn H.; Wilcox, Robert G.; Bentley, Johanne; Braunwald, Eugene

doi:10.1016/s0002-9149(00)01444-2

Cited by 166 publications

(112 citation statements)

References 18 publications

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“…Previous studies have described an association between an increased WBC, measured early after hospitalization for myocardial infarction, and an increased risk of heart failure, cardiogenic shock, and cardiac mortality. [22][23][24] WBC increases with time from symptom onset to presentation with acute myocardial infarction, suggesting that it is influenced by the inflammatory response to myocardial necrosis. 25 The present study provides evidence that an increased WBC measured 5 months to 3 years after myocardial infarction or unstable angina is also associated with a greater long-term cardiovascular risk.…”

Section: Stewart Et Al White Blood Count Pravastatin Coronary Mortamentioning

confidence: 99%

White Blood Cell Count Predicts Reduction in Coronary Heart Disease Mortality With Pravastatin

et al. 2005

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Background-Elevated serum inflammatory marker levels are associated with a greater long-term risk of cardiovascular events. Because 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors (statins) may have an antiinflammatory action, it has been suggested that patients with elevated inflammatory marker levels may have a greater reduction in cardiovascular risk with statin treatment. Methods and Results-We evaluated the association between the white blood cell count (WBC) and coronary heart disease mortality during a mean follow-up of 6.0 years in the Long-Term Intervention With Pravastatin in Ischemic Disease (LIPID) Study, a clinical trial comparing pravastatin (40 mg/d) with a placebo in 9014 stable patients with previous myocardial infarction or unstable angina. An increase in baseline WBC was associated with greater coronary heart disease mortality in patients randomized to placebo (hazard ratio for 1ϫ10 9 /L increase in WBC, 1.18; 95% CI, 1.12 to 1.25; PϽ0.001) but not pravastatin (hazard ratio, 1.02; 95% CI, 0.96 to 1.09; Pϭ0.56; P for interactionϭ0.004). The numbers of coronary heart disease deaths prevented per 1000 patients treated with pravastatin were 0, 9, 30, and 38 for baseline WBC quartiles of Ͻ5.9, 6.0 to 6.9, 7.0 to 8.1, and Ͼ8.2ϫ10 9 /L, respectively. WBC was a stronger predictor of this treatment benefit than the ratio of total to high-density lipoprotein cholesterol and a global measure of cardiac risk. There was also a greater reduction (Pϭ0.052) in the combined incidence of cardiovascular mortality, nonfatal myocardial infarction, and stroke with pravastatin as baseline WBC increased (by quartile: 3, 41, 61, and 60 events prevented per 1000 patients treated, respectively). Conclusions-These

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Section: Stewart Et Al White Blood Count Pravastatin Coronary Mortamentioning

confidence: 99%

White Blood Cell Count Predicts Reduction in Coronary Heart Disease Mortality With Pravastatin

et al. 2005

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“…Later, multi-center studies showed that an increased number of white blood cells was associated with higher mortality, more serious atherosclerosis and a lower response to fibrinolytic treatment [4][5][6] . Despite the important role of leukocytes in atherosclerosis, particularly acute coronary syndrome, little is known about the prevalence of the white blood cell count elements in CAD, particularly monocytes.…”

Section: Resultsmentioning

confidence: 99%

Monocitose é um marcador de risco independente para a doença arterial coronariana

Neto

Mansur

Avakian

et al. 2006

Arq. Bras. Cardiol.

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0,25). RESULTADOS: A análise univariada mostrou maior prevalência de leucocitose na DAC, sendo maior nos pacientes com IAM quando comparados com a DAC estável. O mesmo comportamento foi observado para os monócitos. Porém, a distribuição foi semelhante para as demais células do hemograma. A análise multivariada pelo método da regressão logística, utilizando-se os modelos stepwise (todas variáveis) e backward (p < 0,25), mostrou que a monocitose foi variável independente para DAC e para o IAM. CONCLUSÃO: O número de monócitos, um dos mais importantes componentes do processo inflamatório na placa aterosclerótica, foi um marcador de risco independente para a DAC e para o IAM.]]>

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“…Inflammation post‐AMI is important for healing and influences short‐ and long‐term outcomes 34, 35. Leukocytosis is a strong predictor of mortality and heart failure in patients post‐AMI 36, 37. Moreover, a subset of leukocytes (viz., neutrophils and monocytes) are associated with microvascular injury, LV remodeling, and function 34, 38.…”

Section: Discussionmentioning

confidence: 99%

Durable Benefits of Cellular Postconditioning: Long‐Term Effects of Allogeneic Cardiosphere‐Derived Cells Infused After Reperfusion in Pigs with Acute Myocardial Infarction

Tseliou¹,

Couto²,

Gallet³

et al. 2016

JAHA

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BackgroundInfusion of allogeneic cardiosphere‐derived cells (allo‐CDCs) postreperfusion elicits cardioprotective cellular postconditioning in pigs with acute myocardial infarction. However, the long‐term effects of allo‐CDCs have not been assessed. We performed a placebo‐controlled pivotal study for long‐term evaluation, as well as shorter‐term mechanistic studies.Methods and ResultsMinipigs underwent 1.5‐hour mid‐left anterior descending balloon occlusion followed by reperfusion and were randomized to receive intracoronary allo‐CDCs or vehicle 30 minutes postreperfusion. Left ventriculography (LVG) demonstrated preserved ejection fraction (EF) and attenuation of LV remodeling in CDC‐treated pigs. Pigs underwent cardiac magnetic resonance imaging (MRI) and LVG 1 hour and 8 weeks after therapy to evaluate efficacy. MRI showed improvement of EF and attenuation of LV remodeling immediately after allo‐CDC infusion. In addition, allo‐CDCs improved regional function and decreased hypertrophy 2 months post‐treatment. Histological analysis revealed increased myocardial salvage index, enhanced vascularity, sustained reductions in infarct size/area at risk and scar transmurality, and attenuation of collagen deposition in the infarct zone of allo‐CDC‐treated pigs at 2 months. Allo‐CDCs did not evoke lymphohistiocytic infiltration or systemic humoral memory response. Short‐term experiments designed to probe mechanism revealed antiapoptotic effects of allo‐CDCs on cardiomyocytes and increases in cytoprotective macrophages, but no increase in overall inflammatory cell infiltration 2 hours after cell therapy.ConclusionsAllo‐CDC infusion postreperfusion is safe, improves cardiac function, and attenuates scar size and remodeling. The favorable effects persist for at least 2 months after therapy. Thus, cellular postconditioning confers not only acute cardioprotection, but also lasting structural and functional benefits.

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Association of white blood cell count with increased mortality in acute myocardial infarction and unstable angina pectoris

Cited by 166 publications

References 18 publications

White Blood Cell Count Predicts Reduction in Coronary Heart Disease Mortality With Pravastatin

White Blood Cell Count Predicts Reduction in Coronary Heart Disease Mortality With Pravastatin

Monocitose é um marcador de risco independente para a doença arterial coronariana

Durable Benefits of Cellular Postconditioning: Long‐Term Effects of Allogeneic Cardiosphere‐Derived Cells Infused After Reperfusion in Pigs with Acute Myocardial Infarction

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