Coronary artery disease
Comparison of Usefulness of C-reactive Protein Versus White Blood Cell Count to Predict Outcome After Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2007.09.088Get rights and content

White blood cell (WBC) count and high-sensitive C-reactive protein (hs-CRP) are both used as markers of inflammation and prognosis after an ST elevation myocardial infarction (STEMI), but it is unknown whether they have independent prognostic value. We investigated the association and independent prognostic importance of WBC and hs-CRP after STEMI. In this subanalysis of the On-TIME trial, in 490 of 507 (97%) patients, either WBC count or CRP, and in 362 (71%) patients, both WBC count and CRP, were measured on admission before primary percutaneous coronary intervention. There was no significant correlation between WBC count and CRP (R = 0.080). Higher levels of CRP were associated with a reinfarction or death within 1 year (mean hs-CRP 14.2 ± 20.4 vs 6.1 ± 14.2, p = 0.006), but CRP was not associated with enzymatic infarct size (lactate dehydrogenase, LDHQ48) or left ventricular ejection fraction. A higher baseline WBC count was associated with larger LDHQ48 and lower left ventricular ejection fraction but not with 1-year reinfarction or death. In conclusion, although both WBC count and CRP are markers of inflammation and predictors of outcome after STEMI, we did not find a correlation between baseline WBC count and CRP levels in patients treated with primary percutaneous coronary intervention for STEMI. The mechanisms by which WBC counts predict outcome were related to myocardial infarct size whereas CRP were not.

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Methods

This study concerns a subanalysis of data from the On-TIME trial, a prospective, double-blind, randomized controlled trial investigating early versus late initiation of Tirofiban in STEMI.17 In brief, the 507 patients who were included experienced either >30 minutes of chest pain with >0.2 mV (anterior myocardial infarction) or 0.1 mV (nonanterior myocardial infarction) of ST elevation in 2 contiguous electrocardiographic leads and were available for primary angioplasty within 6 hours after the

Results

In 490 patients (97%) included in the On-TIME trial, either WBC count or CRP was measured. A WBC count was available in 473 of 507 (93%), and in 379 (75%) patients, CRP was measured. Both markers were available in 362 (71%) patients. The baseline characteristics are shown in Table 1. There were no important differences between total included patients in the On-TIME trial and those in which WBC count and/or CRP were determined. The baseline characteristics according to elevated CRP or WBC count

Discussion

This study is the first to compare the prognostic importance of CRP and WBC counts on outcome after primary percutaneous coronary intervention for STEMI. No relationship between CRP and WBC count was found, and the mechanisms by which WBC counts predict outcome are infarct size-related, in contrast to CRP.

Higher levels of CRP have been associated with worse outcome after acute myocardial infarction in multiple studies.4, 5, 6, 7, 8, 9, 10, 11 Even in stable condition, 25 days after a myocardial

Acknowledgment

This study was supported with an educational grant from Merck & Co. The authors thank Vera Derks for preparing this manuscript.

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