Lipinski Michael J, Martin Robert E, Cowley Michael J, Goudreau Evelyne, Malloy Walter N, Johnson Robert E, Vetrovec George W
Division of Cardiology, Virginia Commonwealth University Health Systems, Richmond 23298-0036, USA.
Clin Cardiol. 2006 Jan;29(1):36-41. doi: 10.1002/clc.4960290109.
While morbidity and mortality were shown to be increased in the setting of an elevated white blood cell (WBC) count for patients with acute coronary syndrome, the impact of statin therapy on mortality for patients with an elevated WBC count is unknown in high-risk patients with coronary artery disease.
The goal of this study was to determine whether statin therapy improved survival in patients with elevated WBC count undergoing percutaneous coronary intervention (PCI) with preexisting left ventricular (LV) dysfunction, a population at high risk for adverse outcomes.
We retrospectively evaluated consecutive patient procedures performed at our institution from 1996 through 1999. Patients had a technically adequate angiographic left ventriculogram with a calculated ejection fraction (EF) < or = 50%. Patients with prior coronary artery bypass graft were excluded. Mortality data were retrieved using the U.S. Social Security Death Index. Follow-up ranged from 3.5 to 6.5 years. Means are provided with +/- standard deviation, and p values < 0.05 were considered significant.
Of the study population of 238 patients (average EF 39 +/- 9.8%, mean age 57.5 +/- 12 years, 68% men) 61% underwent PCI for a recent myocardial infarction, 68% received stents, and 65% were discharged on statins. Mean WBC count was 9,000 +/- 3,100 cells/mm3, with 28% of patients having a WBC > or = 10,000 cells/mm3. During follow-up, 27% of our population died. Patients with a WBC > or = 10,000 had worse survival than patients with WBC < 10,000 (1-year survival: 86 vs. 96%, p < 0.05; 3-year survival: 79 vs. 89%, p < 0.05). Survival was significantly improved in patients on statin therapy regardless of WBC count, but the greatest benefit tended to be in patients with WBC > or = 10,000 (WBC > or = 10,000; odds ratio [OR] 5.14, 95% confidence interval [CI] 1.44-19.0, WBC < 10,000; OR 2.79,95% CI 1.13-7.1). Proportional hazard regression analysis demonstrated that both statin therapy and WBC count predicted mortality.
Patients undergoing PCI with LV dysfunction discharged on statins had improved survival regardless of WBC count, with a trend for greater improvement in patients with elevated WBC counts. In addition, WBC count predicts mortality in this high-risk population with LV dysfunction undergoing PCI.
虽然急性冠状动脉综合征患者白细胞（WBC）计数升高时发病率和死亡率会增加，但在患有冠状动脉疾病的高危患者中，他汀类药物治疗对白细胞计数升高患者死亡率的影响尚不清楚。
本研究的目的是确定他汀类药物治疗是否能改善白细胞计数升高且已存在左心室（LV）功能障碍的患者在接受经皮冠状动脉介入治疗（PCI）后的生存率，这是一个不良结局风险较高的人群。
我们回顾性评估了1996年至1999年在我们机构进行的连续患者手术。患者的血管造影左心室造影技术上足够，计算出的射血分数（EF）≤50%。排除既往有冠状动脉旁路移植术的患者。使用美国社会保障死亡指数检索死亡率数据。随访时间为3.5至6.5年。数据以平均值±标准差表示，p值<0.05被认为具有统计学意义。
在238例研究人群中（平均EF 39±9.8%，平均年龄57.5±12岁，68%为男性），61%因近期心肌梗死接受PCI，68%接受了支架置入，65%出院时服用他汀类药物。平均白细胞计数为9000±3100个细胞/mm³，28%的患者白细胞≥10000个细胞/mm³。在随访期间，27%的人群死亡。白细胞≥10000的患者生存率低于白细胞<10000的患者（1年生存率：86%对96%，p<0.05；3年生存率：79%对89%，p<0.05）。无论白细胞计数如何，接受他汀类药物治疗的患者生存率均显著提高，但最大获益倾向于白细胞≥10000的患者（白细胞≥10000；优势比[OR]5.14，95%置信区间[CI]1.44 - 19.0，白细胞<10000；OR 2.79，95%CI 1.13 - 7.1）。比例风险回归分析表明，他汀类药物治疗和白细胞计数均能预测死亡率。
无论白细胞计数如何，接受PCI且LV功能障碍并出院时服用他汀类药物的患者生存率均有所提高，白细胞计数升高的患者改善趋势更明显。此外，白细胞计数可预测这一接受PCI且LV功能障碍的高危人群的死亡率。
