Numerous epidemiologic and clinical studies have shown leukocytosis to be an independent predictor of future cardiovascular events.1 While a causal mechanism has yet to be determined, the relationship remains consistent, temporal and dose-dependent in a wide array of patients, ranging from those free of coronary heart disease to those presenting with acute myocardial infarction (MI).2 In the era of percutaneous coronary intervention (PCI), an elevated preprocedural white blood cell (WBC) count has been associated with worse clinical outcomes in patients undergoing angioplasty with or without bare-metal stent (BMS) placement; however, little is known about how drug-eluting stents (DES) impact this relationship.3 Given reports that DES may lead to reductions in periprocedural markers of inflammation, DES may attenuate the relationship between clinical adverse events and an elevated WBC count.4,5 Studying the relationship between preprocedural WBC count and outcomes is an important step to understanding the utility of WBC count as a prognostic and risk stratification tool in patients headed to the cardiac catheterization laboratory for PCI.
In the single-center registry study by Jurewitz et al published in this month’s Journal, the association between preprocedural WBC count and multiple clinical endpoints is assessed in 878 consecutive patients undergoing PCI at UCLA Medical Center with either Cypher™ or Taxus® DES between April, 2003 and December, 2006. Dividing their cohort into WBC tertiles, the authors measure survival and freedom from major adverse cardiovascular events (MACE) at 1 year post PCI. Significant differences are noted in the baseline characteristics of the WBC subgroups. The highest tertile of WBC count ([T3], ≥ 8.8 x 109 cells/L) has a greater percentage of patients who smoke, present with MI and have a low ejection fraction (EF) (
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