Preoperative white blood cell count is independently associated with higher perioperative cardiac enzyme release and increased 1-year mortality after coronary artery bypass grafting.
BACKGROUND
Elevated preprocedural systemic markers of inflammation, including white blood cell count, have been associated with adverse clinical outcomes after percutaneous coronary intervention. The relationship between preoperative white blood cell count and clinical outcomes after coronary artery bypass grafting is less clear despite increasing evidence that neutrophils participate in reperfusion injury. We sought to determine the relationship between preoperative white blood cell count and in hospital major morbidity and 1-year survival after coronary artery bypass grafting.


METHODS
We prospectively studied 3,024 consecutive isolated coronary artery bypass graft procedures. Preoperative white blood cell count was determined by automated counter, perioperative cardiac enzyme release by the creatine kinase-myocardial band isoenzyme, and all-cause mortality over the first postoperative year taken from a national death registry. Multivariate logistic regression and Cox proportional hazards analyses were performed.


RESULTS
Preoperative white blood cell count offered as a continuous variable and as five predetermined groups was independently associated with cardiac enzyme release three or more times the upper limit of the reference range (adjusted odds ratio = 1.5 per 10 x 10(9)/L increase, 95% confidence interval: 1.2 to 2.0, p = 0.002) and higher 1-year mortality (adjusted hazard ratio = 1.6 per 10 x 10(9)/L increase, 95% confidence interval: 1.2 to 2.1, p < 0.001).


CONCLUSIONS
Higher preoperative white blood cell count is independently associated with higher perioperative myonecrosis and 1-year mortality after coronary artery bypass grafting.
Newall
Nick
N
Department of Cardiology, The Cardiothoracic Centre-Liverpool, Liverpool, United Kingdom.
Grayson
Antony D
AD
Oo
Aung Y
AY
Palmer
Nicholas D
ND
Dihmis
Walid C
WC
Rashid
Abbas
A
Stables
Rodney H
RH
D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D052279:Creatine Kinase, MB Form