American Heart Journal
Volume 147, Issue 1 , Pages 42-48, January 2004

Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE)☆

  • Mark I Furman, MD, FACC

      Affiliations

    • University of Massachusetts Medical School, Worcester, Mass, USA
    • Corresponding Author InformationReprint requests: Mark I. Furman, MD, FACC, Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA, 01655, USA.
    • ,
  • Joel M Gore, MD

      Affiliations

    • University of Massachusetts Medical School, Worcester, Mass, USA
    • ,
  • Fredrick A Anderson, PhD

      Affiliations

    • University of Massachusetts Medical School, Worcester, Mass, USA
    • ,
  • Andrzej Budaj, MD, PhD

      Affiliations

    • Grochowski Hospital, Warsaw, Poland
    • ,
  • Shaun G Goodman, MD

      Affiliations

    • Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
    • ,
  • Ávaro Avezum, MD

      Affiliations

    • CTI-A Hospital Albert Einstein, São Paulo, Brazil
    • ,
  • José López-Sendón, MD

      Affiliations

    • Hospital Universitario Gregorio Marañon, Madrid, Spain
    • ,
  • Werner Klein, MD

      Affiliations

    • Medizinische Universitätsklinik, Klinische Abteilung für Kardiologi, Graz, Austria
    • ,
  • Debabrata Mukherjee, MD

      Affiliations

    • University of Michigan Health System, Ann Arbor, Mich, USA
    • ,
  • Kim A Eagle, MD

      Affiliations

    • University of Michigan Health System, Ann Arbor, Mich, USA
    • ,
  • Omar H Dabbous, MD, MPH

      Affiliations

    • University of Massachusetts Medical School, Worcester, Mass, USA
    • ,
  • Robert J Goldberg, MD

      Affiliations

    • University of Massachusetts Medical School, Worcester, Mass, USA
    • ,
  • GRACE Investigators

      Affiliations

Received 7 March 2003; accepted 15 July 2003.

Abstract 

Objective

To examine the association between elevated leukocyte count and hospital mortality and heart failure in patients enrolled in the multinational, observational Global Registry of Acute Coronary Events (GRACE).

Background

Elevated leukocyte count is associated with adverse hospital outcomes in patients presenting with acute myocardial infarction (AMI). The association of this prognostic factor with hospital mortality and heart failure in patients with other acute coronary syndromes (ACS) is unclear.

Methods

We examined the association between admission leukocyte count and hospital mortality and heart failure in 8269 patients presenting with an ACS. This association was examined separately in patients with ST-segment elevation AMI, non-ST–segment elevation AMI, and unstable angina. Leukocyte count was divided into 4 mutually exclusive groups (Q): Q1 <6000, Q2 = 6000–9999, Q3 = 10,000–11,999, Q4 >12,000. Multiple logistic regression analysis was performed to examine the association between elevated leukocyte count and hospital events while accounting for the simultaneous effect of several potentially confounding variables.

Results

Increasing leukocyte count was significantly associated with hospital death (adjusted odds ratio [OR] 2.8, 95% CI 2.1–3.6 for Q4 compared to Q2 [normal range]) and heart failure (OR 2.7, 95% CI 2.2–3.4) for patients presenting with ACS. This association was seen in patients with ST-segment elevation AMI (OR for hospital death 3.2, 95% CI 2.1–4.7; OR for heart failure 2.4, 95% CI 1.8–3.3), non-ST–segment elevation AMI (OR for hospital death 1.9, 95% CI 1.2–3.0; OR for heart failure 1.7, 95% CI 1.1–2.5), or unstable angina (OR for hospital death 2.8, 95% CI 1.4–5.5; OR for heart failure 2.0, 95% CI 0.9–4.4).

Conclusion

In men and women of all ages with the spectrum of ACS, initial leukocyte count is an independent predictor of hospital death and the development of heart failure.

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☆ The GRACE project is supported by an unrestricted educational grant from Aventis Pharma (Bridgewater, NJ).Guest Editor for this manuscript was Raymond J. Gibbons, MD, Mayo Clinic, Rochester, Minn.

PII: S0002-8703(03)00592-1

doi:10.1016/j.ahj.2003.07.003

American Heart Journal
Volume 147, Issue 1 , Pages 42-48, January 2004

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