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Preprocedural Leucocyte Count Predicts Risk in Patients with Coronary Chronic Total Occlusion
Catherine Gebhard1, Aurel Toma1, Zhao Min1
1Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany.
Insights
Elevated white blood cell (WBC) count predicts worse outcomes in patients undergoing percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO). This inflammatory marker may aid in selecting patients for CTO-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Inflammation Research
Background:
- Percutaneous coronary intervention (PCI) technologies for coronary chronic total occlusions (CTO) have advanced, yet patient selection and long-term benefits remain uncertain.
- White blood cell (WBC) count is linked to cardiovascular risk, suggesting potential prognostic value in CTO-PCI.
- This study investigates the association between WBC count and outcomes in patients undergoing CTO-PCI.
Purpose of the Study:
- To determine if baseline white blood cell (WBC) count provides incremental prognostic value in patients undergoing percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO).
- To assess the relationship between WBC count and clinical outcomes, including all-cause mortality and major adverse cardiac events, in CTO patients.
Main Methods:
- Retrospective analysis of 1,262 consecutive patients undergoing elective PCI between 2002 and 2008.
- Comparison of baseline WBC counts and outcomes between 475 patients with CTO and 787 controls with non-occlusive coronary lesions.
- Statistical analysis including logistic regression, survival analysis (log-rank test), and Cox proportional hazards models with adjustment for confounders.
Main Results:
- Baseline WBC count was significantly higher in CTO patients compared to controls (8,072 vs. 7,469/μL, p=0.001) and independently predicted CTO presence.
- In CTO patients, the highest tertile of WBC count was associated with significantly worse outcomes (all-cause mortality and major adverse cardiac events) after a median follow-up of 3.1 years.
- Elevated WBC count independently predicted all-cause mortality in CTO patients (aHR=3.1, p=0.001) but not in controls.
Conclusions:
- Baseline white blood cell (WBC) count is an independent predictor of adverse outcomes in patients undergoing percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO).
- Assessment of inflammatory status, indicated by WBC count, may assist in identifying high-risk CTO patients who could benefit from CTO-PCI.
- These findings highlight the prognostic significance of inflammation in the context of CTO-PCI.
Abstract:
Background As technologies of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) have improved, great uncertainty exists regarding patient selection and long-term benefit of CTO-PCI. Given that white blood cell (WBC) count has been associated with cardiovascular risk, we hypothesized that the latter might provide incremental prognostic value in patients undergoing CTO-PCI. Methods and Results Our study population consisted of 1,262 consecutive patients (76.3% males, mean age of 67.7 ± 10.3 years) who underwent elective PCI at our centre between January 2002 and December 2008. Four hundred seventy-five patients had at least one CTO, while 787 patients with non-occlusive coronary lesions served as controls. Baseline WBC count was higher in CTO patients as compared with controls (8,072 ± 3,459/μL vs. 7,469 ± 2,668/μL, p = 0.001) and independently predicted the occurrence of a CTO lesion (odds ratio: 1.8; 95% confidence interval [CI]: 1.3-2.4; p < 0.001). After a median follow-up of 3.1 years (interquartile range: 2.1-4.2 years), CTO patients with WBC counts ranging in the highest tertile had significantly worse outcomes than CTO patients with lower WBC counts (log-rank = 0.009 for all-cause mortality and log-rank = 0.01 for major adverse cardiac events). These associations were not seen in controls. Accordingly, elevated WBC count was identified as a significant predictor for all-cause mortality (adjusted hazard ratio: 3.1; 95% CI: 1.6-6.2; p = 0.001) in CTO patients but not in patients with non-occlusive coronary artery disease (pint = 0.088). Conclusion Assessment of the inflammatory status of CTO patients may be an important element in selecting CTO patients at low risk who may be referred to CTO-PCI.
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