Preprocedural White Blood Cell Count as a Predictor of Death and Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention with Drug-Eluting Stents

BACKGROUND: Patients with elevated white blood cell (WBC) counts who undergo percutaneous coronary intervention (PCI) are at increased risk for short- and long-term mortality as well as major adverse cardiac events (MACE). We assessed the relationship between elevated WBC counts and clinical events in patients who underwent PCI with drug-eluting stents (DES). METHODS: Our retrospective study includes 878 consecutive patients who underwent both elective and emergent PCI with DES at the UCLA Medical Center. The cohort was divided into tertiles based upon the presenting WBC count: 2.8-6.3 x 109 cells/L (tertile 1 [T1]), 6.4-8.7 x 109 cells/L (tertile 2 [T2]), ≥ 8.8 x 109 cells/L (tertile 3 [T3]). RESULTS: Survival at 1 year was significantly different between all three tertiles, and was poorest in patients with WBC counts in T3 (93.9-T1, 98.4-T2, 87.3-T3; p < 0.0001), while T2 had the highest survival rate at 1 year. Age, chronic renal insufficiency, chronic obstructive pulmonary disease, low WBC count in T1, elevated WBC count in T3 and presentation with myocardial infarction were identified as multivariable predictors for survival at 1 year. CONCLUSION: Both elevated and low WBC counts are associated with increased mortality and MACE at 1 year following PCI with DES. WBC count is an independent predictor of survival in patients who undergo PCI with DES implantation.