Binita Shah1, Usman Baber1, Stuart J Pocock1, Mitchell W Krucoff1, Cono Ariti1, C Michael Gibson1, Philippe Gabriel Steg1, Giora Weisz1, Bernhard Witzenbichler1, Timothy D Henry1, Annapoorna S Kini1, Thomas Stuckey1, David J Cohen1, Ioannis Iakovou1, George Dangas1, Melissa B Aquino1, Samantha Sartori1, Alaide Chieffo1, David J Moliterno1, Antonio Colombo1, Roxana Mehran2. 1. 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.). 2. 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.). roxana.mehran@mountsinai.org.
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. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00998127.
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. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00998127.
Authors: Spyridon G Deftereos; Frans J Beerkens; Binita Shah; George Giannopoulos; Dimitrios A Vrachatis; Sotiria G Giotaki; Gerasimos Siasos; Johny Nicolas; Clare Arnott; Sanjay Patel; Mark Parsons; Jean-Claude Tardif; Jason C Kovacic; George D Dangas Journal: Circulation Date: 2021-12-29 Impact factor: 29.690
Authors: Binita Shah; Michael Pillinger; Hua Zhong; Bruce Cronstein; Yuhe Xia; Jeffrey D Lorin; Nathaniel R Smilowitz; Frederick Feit; Nicole Ratnapala; Norma M Keller; Stuart D Katz Journal: Circ Cardiovasc Interv Date: 2020-04-16 Impact factor: 6.546