Flow resistance of individual neutrophils in coronary artery disease: decreased pore transit times in acute myocardial infarction

Neutrophil count on admission predicts major in-hospital events in patients with a non-ST-segment elevation acute coronary syndrome

BACKGROUND

Inflammation plays a key role in the pathogenesis of acute coronary syndromes (ACS). In this context we assessed neutrophil count as a predictor of major in-hospital events in patients admitted for a non-ST-segment elevation (NSTE) ACS.

METHODS

We measured neutrophils on admission in 160 patients with a NSTE ACS and we correlated their count with the incidence of a combined in-hospital end point including: cardiac death, acute heart failure, ST-segment elevation myocardial infarction, and recurrent myocardial ischemia.

RESULTS

Patients who had a major in-hospital event also had a higher neutrophil count (P = 0.02) and higher serum levels of troponin I (P = 0.04). In the univariate logistic regression analysis, in-hospital major events could be predicted by troponin I > 0.07 ng/mL (odds ratio [OR]: 5.65, 95% confidence interval [CI]: 1.26-25.32, P = 0.02), white blood cell count > 8650 cells/microL (OR: 2.68, 95% CI: 1.03-6.95, P = 0.04), neutrophil count > 6700 cells/microL (OR: 7.74, 95% CI: 2.79-21.47, P < 0.001), and C-reactive protein > 0.97 mg/dL (OR: 3.56, 95% CI: 1.13-11.19, P = 0.02). However, in multivariate regression, neutrophil count > 6700 cells/microL (OR: 6.52, 95% CI: 1.56-27.22, P = 0.01) was the only independent in-hospital prognostic factor.

CONCLUSIONS

In patients with a NSTE ACS of moderate or high risk, neutrophil count on admission may identify those who are at risk of having an adverse in-hospital outcome.

Relationship between white blood cell count and Framingham Risk Score in asymptomatic men

BACKGROUND

There is an independent association between white blood cell (WBC) and coronary heart disease (CHD) risk. However, the relationship between WBC and Framingham Risk Score (FRS) remains unclear.

METHODS

This is a cross-sectional study on a consecutive sample of 520 white asymptomatic men (mean age 46 +/- 7 years) without CHD. The study population was divided into WBC quartiles (x10(9) cells/L): 1(st) quartile: 3.1-5.3 (n = 139), 2(nd) quartile: 5.4-6.1 (n = 129), 3(rd) quartile: 6.2-7.1 (n = 131), 4(th) quartile: >/=7.2 (n = 121), and into tertiles according to the 10-year FRS: 1(st) tertile (low risk <5%, n = 180, 35%), 2(nd) tertile (intermediate risk 5-12%, n = 210, 40%), 3(rd) tertile (high risk: >/=13%, n = 130, 25%).

RESULTS

WBC correlated only weakly with FRS (r = 0.18, p = 0.001). Among individual components of FRS, WBC correlated minimally with smoking (r = 0.12, p = 0.003), systolic blood pressure (r = 0.07, p = 0.1), and high-density lipoprotein cholesterol (r = -0.06, p = 0.1). However, no correlation was observed with age (p = 0.3) and total cholesterol (p = 0.5). Nearly one third (31%) of men in the low-risk (FRS <5%) had WBC count in the 1(st) quartile compared to 20% of those classified as high risk (FRS >/=13%). The prevalence of WBC in the 4(th) quartile increased across FRS tertiles (18, 22, 32%) (p = 0.09).

CONCLUSIONS

WBC correlates weakly with FRS or its individual components. Since WBC count is strongly related to CHD, WBC may reflect different components of cardiovascular risk, which might not be captured by traditional cardiovascular risk factors used in calculating FRS. Inflammatory biomarkers afford adjunctive value to FRS and may be used to improve CHD risk stratification.