Abstract 3747: Elevated Lymphocyte Count Prior to Coronary Stenting is the Best Predictor of Long-Term Outcome Among White Blood Cell Subtypes
Background The total white blood cell (WBC) count has been shown to be associated with long-term mortality in patients with CAD, but controversy exists on which WBC subtype is the best predictor of mortality. The aim of this study was to compare the prognostic value of a pre-procedural lymphocyte count to the neutrophil and monocyte count in patients receiving PCI.
Methods Retrospective analysis of the Mayo PCI registry was performed on patients who underwent successful coronary stenting from 1995–2005 and survived to hospital discharge.
Results A total of 9015 patients were grouped based on their lymphocyte count into quartiles (Q); Q1 (< 1.2 x 109; n=2323), Q2 (1.2 – 1.6 x 109; n=2126), Q3 (1.6 – 2.1 x 109; n=2178) and Q4 (> 2.1 x 109; n=2388). Compared with the lowest quartile, the highest quartile was significantly associated (all p<0.001) with less procedural shock (2% vs. 7%); fewer patients with LVEF < 40% (9% vs. 15%); lower levels of lower levels of CK-MB (3.2 vs. 5.2) and troponin T (0.03 vs. 0.17); and fewer type C lesions (40% vs. 51%). There were 1620 deaths over a median follow up of 5.1 years. Following multivariate adjustment, an elevated lymphocyte count was independently associated with lower rates of death, cardiac death, and death or MI in follow-up, but not of target lesion revascularization. When compared to the neutrophil, monocyte and total WBC counts in the same model, the pre-procedural lymphocyte count was the strongest predictor of death (Figure⇓).
Conclusions Elevated lymphocyte count prior to PCI correlates with decreased CK-MB and troponin, angiographically less severe lesions and is a strong independent predictor of favorable long-term outcome.