Predictive value of postprocedural leukocyte count on myocardial perfusion, left ventricular function and clinical...

Area of Science:

• Cardiology
• Hematology
• Interventional Cardiology

Background:

• Baseline white blood cell (WBC) count is associated with ischemic events in ST-elevated myocardial infarction (STEMI) patients.
• Circulating WBC counts can be altered following percutaneous coronary intervention (PCI).
• The prognostic value of postprocedural WBC count in STEMI patients undergoing PCI requires further investigation.

Purpose of the Study:

• To evaluate the association between postprocedural WBC count and clinical outcomes in STEMI patients treated with primary PCI.
• To determine if postprocedural WBC count predicts myocardial reperfusion and left ventricular function after PCI.

Main Methods:

• A cohort of 242 consecutive STEMI patients undergoing successful primary PCI were followed for two years.
• WBC counts were assessed within 12 hours post-PCI; ST-segment resolution (ST-R) and myocardial blush grade (MBG) were evaluated immediately.
• Left ventricular ejection fraction (LVEF) was measured at baseline and 12-18 months post-PCI.

Main Results:

• Postprocedural WBC count was an independent inverse predictor of ST-R and MBG 3 (P < 0.0001 for both).
• Higher WBC counts were negatively correlated with LVEF at baseline (r = -0.22, P = 0.001) and 12-18 months (r = -0.29, P < 0.0001).
• A WBC count > 13.0 × 10(9)/L was associated with significantly lower survival rates at 30 days (82.4% vs. 99.0%, P < 0.0001) and 2 years (75.0% vs. 96.4%, P < 0.0001), and was a strong independent predictor of mortality (30-day HR 8.48, P = 0.019; 2-year HR 4.93, P = 0.009).

Conclusions:

• Elevated postprocedural WBC count in STEMI patients undergoing PCI correlates with myocardial malperfusion and impaired left ventricular function.
• Postprocedural WBC count serves as an independent predictor of adverse clinical outcomes, including mortality, in this patient population.