The predictive value of white blood cell count on the success of primary percutaneous intervention of the left anterior descending artery in patients admitted with acute anterior wall myocardial infarction.
Background: Epidemiological studies have shown correlations between the white blood cell (WBC) count and the risk of acute myocardial infarction (AMI) and stroke. The risk of AMI is four times as great in patients with WBC counts in the high-normal range (>9000/microl) as it is in those in the low-normal range (<6000/microl). A high WBC count also predicts a greater risk of re-infarction and in-hospital death. Data are still missing about the role of WBC count in the success rate of primary angioplasty. Methods: A total of 125 consecutive patients aged 40-65 years (mean age 54+/-8 years) had a primary percutaneous coronary intervention (PCI) as their first-line therapy for AMI. We evaluated interrelationships between WBC count, hemoglobin (Hg), platelets (PLT), heart rate (HR), left ventricular systolic (LVS) pressure, left ventricular diastolic (LVD) pressure, and the success rate of primary angioplasty to the occluded left anterior descending artery (LAD) in patients with AMI. Results: Of the 125 patients (30 females and 95 males), 72 underwent primary PCI to the LAD and 31 patients were referred for an emergency coronary artery bypass graft surgery (CABG). One patient died. Twenty-one patients had non-occluded arteries, most of them with a fresh thrombus and after spontaneous reperfusion. Multiple logistic dregression analysis demonstrated that low ejection fraction (p=0.01) and high WBC counts (p=0.04) were correlated with failure of angioplasty and referral for an emergency CABG. WBC counts were positively correlated with heart rate (p=0.005), platelet count (p=0.0006), and Hg level (p=0.001). Conclusions: These data suggest that measuring WBC count on admission to the catheterization laboratory for primary angioplasty provides clinically important prognostic information.
Blum
Arnon
A
Department of Internal Medicine A, Poria Hospital, Lower Galilee, Israel.
Massachi
Rafael
R
Miller
Hylton
H