White blood cell count and major adverse cardiovascular events after percutaneous coronary intervention in the contemporary era insights from the Paris study (Patterns of non-adherence to anti-platelet regimens in stented patients registry)

Binita Shah, Usman Baber, Stuart J. Pocock, Mitchell W. Krucoff, Cono Ariti, C. Michael Gibson, Philippe Gabriel Steg, Giora Weisz, Bernhard Witzenbichler, Timothy D. Henry, Annapoorna S. Kini, Thomas Stuckey, David J. Cohen, Ioannis Iakovou, George Dangas, Melissa B. Aquino, Samantha Sartori, Alaide Chieffo, David J. Moliterno, Antonio ColomboRoxana Mehran

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: Elevated white blood cell (WBC) count is associated with increased major adverse cardiovascular events (MACE) in the setting of acute coronary syndrome. The aim of this study was to evaluate whether similar associations persist in an all-comers population of patients undergoing percutaneous coronary intervention in the contemporary era. Methods and Results: In the multicenter, prospective, observational Paris study (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Registry), 4222 patients who underwent percutaneous coronary intervention in the United States and Europe between July 1, 2009, and December 2, 2010, were evaluated. The associations between baseline WBC and MACE (composite of cardiac death, stent thrombosis, spontaneous myocardial infarction, or target lesion revascularization) at 24-month follow-up were analyzed using multivariable Cox regression. Patients with higher WBC were more often younger, smokers, and with less comorbid risk factors compared with those with lower WBC. After adjustment for baseline and procedural characteristics, WBC remained independently associated with MACE (hazard ratio [HR] per 103 cells/μL increase, 1.05 [95% confidence intervals (CI), 1.02-1.09]; P=0.001), cardiac death (HR, 1.10 [95% CI, 1.05-1.17]; P<0.001), and clinically indicated target revascularization (HR, 1.04 [95% CI, 1.00-1.09]; P=0.03) but not stent thrombosis (HR, 1.07 [95% CI, 0.99-1.16]; P=0.10) or spontaneous myocardial infarction (HR, 1.03 [95% CI, 0.97-1.09]; P=0.29). The association between WBC and MACE was consistent in acute coronary syndrome and non-acute coronary syndrome presentations (interaction P=0.15). Conclusions: Increased WBC is an independent predictor of MACE after percutaneous coronary intervention in a contemporary all-comers cohort. Further studies to delineate the underlying pathophysiologic role of elevated WBC across a spectrum of coronary artery disease presentations are warranted.

Original languageEnglish
Article numbere004981
JournalCirculation: Cardiovascular Interventions
Volume10
Issue number8
DOIs
StatePublished - Aug 1 2017

Bibliographical note

Funding Information:
The PARIS registry was funded, in part, by Bristol-Myers Squibb and Sanofi-Aventis. Dr Shah is supported, in part, by the Biomedical Laboratory Research and Development Service of the Veterans Affairs Office of Research and Development (IK2 CX001074).

Funding Information:
From the Department of Medicine (Cardiology), New York Harbor Health Care System, Manhattan VA Hospital (B.S.); Department of Medicine (Cardiology), New York University School of Medicine (B.S.); Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (U.B., A.S.K., G.D., M.B.A., S.S., R.M.); Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P., C.A.); Department of Medicine (Cardiology), Duke University School of Medicine, Durham, NC (M.W.K.); Department of Medicine (Cardiology), Harvard Medical School, Cambridge, MA (C.M.G.); Department of Medicine (Cardiology), Hôpital Bichat-Claude Bernard, Paris, France (P.G.S.); Department of Medicine (Cardiology), Columbia University Medical Center, New York, NY (G.W.); Department of Medicine (Cardiology), HELIOS Amper-Klinikum Dachau, Germany (B.W.); Department of Medicine (Cardiology), Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Department of Medicine (Cardiology), Minneapolis Heart Institute Foundation, University of Minnesota (T.D.H.); Department of Medicine (Cardiology), Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, NC (T.S.); Department of Medicine (Cardiology), St Luke’s Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Department of Medicine (Cardiology), Onassis Cardiac Surgery Center, Athens, Greece (I.I.); Department of Medicine (Cardiology), San Raffaele Hospital, Milan, Italy (A. Chieffo, A. Colombo); and Department of Medicine (Cardiology), University of Kentucky, Lexington (D.J.M.).

Publisher Copyright:
© 2017 American Heart Association, Inc.

Keywords

  • Acute coronary syndrome
  • Coronary artery disease
  • Leukocytes
  • Myocardial infarction
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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