title: Impact of prodromal angina pectoris and white blood cell count on outcome of patients with acute myocardial infarction.
abstract: BACKGROUND
  Elevation of white blood cell (WBC) count at admission is associated with adverse outcome after acute myocardial infarction (AMI). Prodromal angina, by the mechanism of ischemic preconditioning, improves left ventricular (LV) function and survival after reperfusion therapy in patients with AMI. Recent experimental studies have reported that preconditioning has anti-inflammatory effect.
  
  
  METHODS
  This study consisted of 598 patients with first anterior wall AMI who underwent coronary angiography within 12 h after symptom onset. WBC count was measured at the time of hospital admission. Prodromal angina was defined as angina occurring within 24 h before the onset of AMI. Serial measurements of LV ejection fraction (EF) were obtained before reperfusion therapy and before discharge in 421 patients (71%).
  
  
  RESULTS
  High WBC count (>10.2 x 103/mm3, n=297) was associated with higher 30-day mortality (8% vs. 4%, p=0.02) and lower predischarge LVEF (51+/-15% vs. 57+/-14%, p<0.001), although there was no significant difference in acute LVEF (47+/-10% vs. 49+/-11%, p=0.07). High WBC count was an independent predictor of 30-day mortality (p=0.009) and predischarge LVEF (p=0.002). Prodromal angina was associated with lower 30-day mortality (3% vs. 7%, p=0.02) and preserved predischarge LVEF (57+/-15% vs. 53+/-14%, p=0.006). Patients with prodromal angina had lower WBC count (10.0+/-3.3 x 10(3)/mm3 vs. 11.0+/-3.9 x 10(3)/mm3, p=0.001) and prodromal angina was an independent predictor of WBC count (p<0.001).
  
  
  CONCLUSIONS
  Elevation of WBC count and lack of prodromal angina were associated with impaired LV function and mortality after reperfusion in patients with AMI. Prodromal angina might have contributed to favorable outcome after AMI through its anti-inflammatory effect.
authors.affiliation: Department of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan. ishifami@fb3.so-net.ne.jp
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.forename: Ichiro
authors.initials: I
authors.lastname: Inoue
authors.forename: Takuji
authors.initials: T
authors.lastname: Kawagoe
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shimatani
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kurisu
authors.forename: Takaki
authors.initials: T
authors.lastname: Hata
authors.forename: Naoya
authors.initials: N
authors.lastname: Mitsuba
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Kisaka
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D010343:Patient Admission; D010351:Patient Discharge; D011237:Predictive Value of Tests; D012044:Regression Analysis; D013318:Stroke Volume; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology; D016277:Ventricular Function, Left