title: Impact of leukocyte count on mortality and bleeding in patients with myocardial infarction undergoing primary percutaneous coronary interventions: analysis from the Harmonizing Outcome with Revascularization and Stent in Acute Myocardial Infarction trial.
abstract: BACKGROUND
  The relationship between white blood cell count (WBCc) and mortality in patients with ST-segment-elevation acute myocardial infarction treated with percutaneous coronary intervention is poorly understood. Furthermore, whether there is a relationship between WBCc and risk of noncardiac mortality and bleeding after percutaneous coronary intervention is unknown.
  
  
  RESULTS
  The baseline WBCc was available in 3193 of 3345 patients (95.5%) who underwent percutaneous coronary intervention in the Harmonizing Outcome With Revascularization and Stent in Acute Myocardial Infarction (HORIZONS-AMI) trial. In a propensity-adjusted multivariable analysis, WBCc was an independent predictor of 1-year cardiac mortality (hazard ratio, 1.15; 95% confidence interval, 1.09 to 1.22), noncardiac mortality (hazard ratio, 1.19; 95% confidence interval, 1.10 to 1.29), and major bleeding (hazard ratio, 1.08; 95% confidence interval, 1.04 to 1.12). After adjustment for baseline creatinine phosphokinase levels and left ventricular ejection fraction, WBCc remained an independent predictor of 1-year all-cause mortality and cardiac mortality. In patients matched for baseline creatinine phosphokinase levels at hospital admission, the median peak creatinine phosphokinase level was significantly higher in patients with high WBCc (>11 000 per 1 mm(3)) compared with low WBCc (1851 U/L [range, 880-3307 U/L] versus 1241 U/L [range, 540 to 2,78], respectively; P<0.0001). In this subgroup of patients, WBCc was an independent correlate of peak creatinine phosphokinase level, and remained an independent predictor of 1-year mortality.
  
  
  CONCLUSIONS
  In patients with ST-segment-elevation acute myocardial infarction undergoing percutaneous coronary intervention, elevated baseline WBCc is an independent predictor of infarct size, as assessed by peak creatinine phosphokinase level, and of 1-year cardiac mortality, noncardiac mortality, and major bleeding.
authors.affiliation: Istituto Cardiologia, Policlinico S. Orsola, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Eugenia
authors.initials: E
authors.lastname: Nikolsky
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Darius
authors.initials: D
authors.lastname: Dudek
authors.forename: Philippe
authors.initials: P
authors.lastname: Genereux
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.forename: LeRoy
authors.initials: L
authors.lastname: Rabbani
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Helen
authors.initials: H
authors.lastname: Parise
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Bruce
authors.initials: B
authors.lastname: Brodie
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lansky
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006470:Hemorrhage / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007958:Leukocyte Count / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000276:immunology / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*
chemical_list: D003402:Creatine Kinase