Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE).
OBJECTIVE
To examine the association between elevated leukocyte count and hospital mortality and heart failure in patients enrolled in the multinational, observational Global Registry of Acute Coronary Events (GRACE).


BACKGROUND
Elevated leukocyte count is associated with adverse hospital outcomes in patients presenting with acute myocardial infarction (AMI). The association of this prognostic factor with hospital mortality and heart failure in patients with other acute coronary syndromes (ACS) is unclear.


METHODS
We examined the association between admission leukocyte count and hospital mortality and heart failure in 8269 patients presenting with an ACS. This association was examined separately in patients with ST-segment elevation AMI, non-ST-segment elevation AMI, and unstable angina. Leukocyte count was divided into 4 mutually exclusive groups (Q): Q1 <6000, Q2 = 6000-9999, Q3 = 10,000-11,999, Q4 >12,000. Multiple logistic regression analysis was performed to examine the association between elevated leukocyte count and hospital events while accounting for the simultaneous effect of several potentially confounding variables.


RESULTS
Increasing leukocyte count was significantly associated with hospital death (adjusted odds ratio [OR] 2.8, 95% CI 2.1-3.6 for Q4 compared to Q2 [normal range]) and heart failure (OR 2.7, 95% CI 2.2-3.4) for patients presenting with ACS. This association was seen in patients with ST-segment elevation AMI (OR for hospital death 3.2, 95% CI 2.1-4.7; OR for heart failure 2.4, 95% CI 1.8-3.3), non-ST-segment elevation AMI (OR for hospital death 1.9, 95% CI 1.2-3.0; OR for heart failure 1.7, 95% CI 1.1-2.5), or unstable angina (OR for hospital death 2.8, 95% CI 1.4-5.5; OR for heart failure 2.0, 95% CI 0.9-4.4).


CONCLUSIONS
In men and women of all ages with the spectrum of ACS, initial leukocyte count is an independent predictor of hospital death and the development of heart failure.
Furman
Mark I
MI
Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass 01655, USA. mark.furman@umassmed.edu
Gore
Joel M
JM
Anderson
Fredrick A
FA
Budaj
Andrzej
A
Goodman
Shaun G
SG
Avezum
Avaro
A
López-Sendón
José
J
Klein
Werner
W
Mukherjee
Debabrata
D
Eagle
Kim A
KA
Dabbous
Omar H
OH
Goldberg
Robert J
RJ
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000097:blood / Q000401:mortality*; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality*; D011237:Predictive Value of Tests; D013577:Syndrome