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Thromb Haemost 2017; 117(11): 2105-2115
DOI: 10.1160/TH17-06-0381
Blood Cells, Inflammation and Infection
Schattauer GmbH Stuttgart

Preprocedural Leucocyte Count Predicts Risk in Patients with Coronary Chronic Total Occlusion

Catherine Gebhard   *
,
Aurel Toma   *
,
Zhao Min
,
Barbara E. Stähli
,
Kambis Mashayekhi
,
Michael Gick
,
Miroslaw Ferenc
,
Heinz Joachim Büttner
,
Franz-Josef Neumann
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Publikationsverlauf

02. Juni 2017

07. August 2017

Publikationsdatum:
30. November 2017 (online)

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Abstract

Background As technologies of percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTO) have improved, great uncertainty exists regarding patient selection and long-term benefit of CTO-PCI. Given that white blood cell (WBC) count has been associated with cardiovascular risk, we hypothesized that the latter might provide incremental prognostic value in patients undergoing CTO-PCI.

Methods and Results Our study population consisted of 1,262 consecutive patients (76.3% males, mean age of 67.7 ± 10.3 years) who underwent elective PCI at our centre between January 2002 and December 2008. Four hundred seventy-five patients had at least one CTO, while 787 patients with non-occlusive coronary lesions served as controls. Baseline WBC count was higher in CTO patients as compared with controls (8,072 ± 3,459/μL vs. 7,469 ± 2,668/μL, p = 0.001) and independently predicted the occurrence of a CTO lesion (odds ratio: 1.8; 95% confidence interval [CI]: 1.3–2.4; p < 0.001). After a median follow-up of 3.1 years (interquartile range: 2.1–4.2 years), CTO patients with WBC counts ranging in the highest tertile had significantly worse outcomes than CTO patients with lower WBC counts (log-rank = 0.009 for all-cause mortality and log-rank = 0.01 for major adverse cardiac events). These associations were not seen in controls. Accordingly, elevated WBC count was identified as a significant predictor for all-cause mortality (adjusted hazard ratio: 3.1; 95% CI: 1.6–6.2; p = 0.001) in CTO patients but not in patients with non-occlusive coronary artery disease (p int = 0.088).

Conclusion Assessment of the inflammatory status of CTO patients may be an important element in selecting CTO patients at low risk who may be referred to CTO-PCI.

Keywords

coronary chronic total occlusion - leucocytes - mortality

* These authors contributed equally to this work.