title: [The usefulness of complete blood count in predicting cardiac rehabilitation failure in post-NSTEMI patients].
abstract: ACS (acute coronary syndrome) NSTEMI is more prevalent than ACS STEMI. Within four years the mortality rate was twice higher in NSTEMI group than in the STEMI group. Studies have demonstrated that cardiac rehabilitation decreases the risk of all-cause mortality as well as the mortality related to cardiovascular events.
  
  
  OBJECTIVE
  The aim of the study was to evaluate with the use of an index of own design the prognostic value of the complete blood count (CBC) in predicting cardiac rehabilitation failure in post-NSTEMI patients.
  
  
  METHODS
  The study comprised 116 post-NSTEMI patients, 81 men and 35 women, aged 64,12±11,29 years, admitted for cardiac rehabilitation to the Department of Internal Medicine and Cardiac Rehabilitation, MU in Lodz. On admission fasting blood cell count was performed, serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose level ≥100 mg/dl, GFR<60 ml/min/1.73m2, RBC < 4x106 μl, WBC > 10x103/μl, PLT < 150x103/μl. Exercise test (cycloergometer) was performed twice in all patients - before and after the completion (4 weeks) of the II phase of the rehabilitation to assess its effects.
  
  
  RESULTS
  Basing on logistic regression analysis and the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of patient's inability to tolerate any workload increment (0 Watt) between the initial and final result of the exercise test despite the applied cardiac rehabilitation program. The most statistically significant risk factors were selected as the result of logistic regression model building on the basis of which cardiac rehabilitation failure index was determined. Anemia and leucocytosis determined most significantly the failure of cardiac rehabilitation (respectively OR=2,77 and OR=2,36; p=0,01). They were used to construct a rehabilitation failure index with the values ranging from 0 to 2, where 0 - corresponds to absence of anemia and leucocytosis, 1 - corresponds to the occurrence of anemia or leucocytosis in post-NSTEMI patients and was associated with 2,65-fold increase of the risk of cardiac rehabilitation failure, 2 - corresponds to simultaneous occurrence of anemia and leucocytosis and was associated with 7,02-fold increase of the risk of cardiac rehabilitation failure.
  
  
  CONCLUSIONS
  Complete blood count is useful in predicting cardiac rehabilitation failure. Anemia and leucocytosis are the most significant determinants of cardiac rehabilitation failure in post-NSTEMI patients. Cardiac rehabilitation failure index can be used for its individual programming. Then optimal rehabilitation effects can be obtained maintaining its safety in post-NSTEMI patients.
authors.affiliation: Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Obrębska-Stefaniak
authors.affiliation: Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz.
authors.forename: Robert
authors.initials: R
authors.lastname: Irzmański
authors.affiliation: Department of Interventional Cardiology and Arrhythmias, Medical University of Lodz.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Grycewicz
authors.affiliation: Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kapusta
authors.affiliation: Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz; University of Social Sciences in Lodz.
authors.forename: Jan
authors.initials: J
authors.lastname: Kowalski
mesh_terms: D000368:Aged; D001772:Blood Cell Count; D000072038:Cardiac Rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000097:blood / Q000534:rehabilitation*; D011379:Prognosis
keywords: NSTEMI; anemia; cardiac rehabilitation; leucocytosis