title: Preprocedural white blood cell count and death after percutaneous coronary intervention.
abstract: BACKGROUND
  Elevated inflammatory markers are associated with worse outcome after percutaneous coronary artery interventions (PCI). An elevation in the white blood cell (WBC) count is a nonspecific response to inflammation. We hypothesized that an elevated WBC count would be a predictor of death in patients undergoing PCI.
  
  
  METHODS
  A total of 4450 patients undergoing percutaneous coronary artery intervention were divided into quintiles, based on their preprocedural WBC count (mean WBC count: quintile 1, 5.08 x 10(3)/muL; quintile 2, 6.58 x 10(3)/muL; quintile 3, 7.70 x 10(3)/muL; quintile 4, 9.14 x 10(3)/muL; and quintile 5, 13.4 x 10(3)/muL). Vital status was assessed through the use of the Social Security Death Index.
  
  
  RESULTS
  There were a total of 504 deaths over a follow-up period of 48 months. The best survival was seen in quintile 2, with an increase in long-term mortality rates seen with both a higher or a lower WBC count (P <.001). This J-shaped curve was preserved after multivariate adjustment, with the adjusted hazard ratio of mortality relative to quintile 2 being 1.95 (95% CI, 1.40 to 2.73) in quintile 1, 1.66 (95% CI, 1.18 to 2.33) in quintile 3, 2.31 (95% CI, 1.67 to 3.17) in quintile 4, and 2.42 (95% CI, 1.76 to 3.34) in quintile 5.
  
  
  CONCLUSIONS
  A low or an elevated preprocedural WBC count in patients undergoing PCI is associated with an increased risk of long-term death. Our result provides further evidence to support the important role of inflammation in coronary artery disease.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Ritesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lauer
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D015415:Biomarkers