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White blood cell count and clinical outcomes after left main coronary artery revascularization: insights from the
Bimmer E Claessen1, Ori Ben-Yehuda2,3,4, Roxana Mehran1,2
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai.
Insights
Elevated white blood cell count (WBCc) does not predict outcomes in patients undergoing left main coronary artery disease (LMCAD) revascularization. This finding suggests WBCc should not be used to guide treatment decisions for LMCAD patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Previous studies suggest a link between elevated white blood cell count (WBCc) and adverse outcomes post-coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
- The prognostic significance of WBCc in patients with left main coronary artery disease (LMCAD) undergoing revascularization requires further investigation.
Purpose of the Study:
- To evaluate the prognostic impact of baseline white blood cell count (WBCc) on clinical outcomes in patients with left main coronary artery disease (LMCAD) treated with either PCI or CABG.
Main Methods:
- Analysis of data from the EXCEL trial, which randomized 1905 patients with LMCAD to PCI or CABG.
- Patients (n=1895) were stratified into tertiles based on baseline WBCc.
- Clinical outcomes, including death, myocardial infarction, stroke, bleeding, stent thrombosis, graft occlusion, and ischemia-driven revascularization, were assessed at 30 days and 5 years.
Main Results:
- Five-year rates of the primary composite endpoint (death, myocardial infarction, or stroke) were similar across all WBCc tertiles (21.2%, 18.9%, 21.6%; P=0.46).
- No significant differences were observed in individual components of the primary endpoint, bleeding events, thrombotic events, or repeat revascularization rates among WBCc groups.
- Multivariable analysis indicated that WBCc was not an independent predictor of adverse events (Hazard Ratio per 1×10^9/L: 1.02; 95% CI, 0.97-1.08; P=0.43).
Conclusions:
- Baseline WBCc is not associated with 30-day or 5-year clinical outcomes following PCI or CABG in patients with LMCAD.
- WBCc should not be routinely utilized as a prognostic marker or to guide revascularization decisions in this patient population.
Background:
Prior studies have reported an association between elevated white blood cell count (WBCc) and worse clinical outcomes after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). We assessed the prognostic impact of WBCc in patients undergoing revascularization for left main coronary artery disease (LMCAD).
Methods:
In Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL), 1905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. The 1895 patients with baseline WBCc available were grouped in tertiles of WBCc (mean 5.6 ± 0.8, 7.5 ± 0.5, and 10.1 ± 1.6 × 109/L).
Results:
Five-year rates of the primary endpoint (death, myocardial infarction or stroke) were similar across increasing WBCc tertiles (21.2, 18.9, and 21.6%; P = 0.46). Individual components of the primary endpoint, Bleeding Academic Research Consortium (BARC) 3-5 bleeding, stent thrombosis or graft occlusion and ischemia-driven revascularization were all similar across WBCc tertiles. By multivariable analysis, WBCc as a continuous variable was not an independent predictor of adverse events (hazard radio per 1 × 109/L: 1.02; 95% CI, 0.97-1.08; P = 0.43). Results were consistent in the PCI and CABG arms individually.
Conclusion:
There was no association between baseline WBCc and 30-day or 5-year clinical outcomes after PCI or CABG. The absence of a clear incremental increase in events with increasing WBCc in the current analysis indicates that WBCc should not routinely be used as a prognostic marker or to guide revascularization decisions in patients with LMCAD.
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