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(Circulation. 2000;102:2329.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Association Between White Blood Cell Count, Epicardial Blood Flow, Myocardial Perfusion, and Clinical Outcomes in the Setting of Acute Myocardial Infarction

A Thrombolysis In Myocardial Infarction 10 Substudy

Hal V. Barron, MD; Christopher P. Cannon, MD; Sabina A. Murphy, MPH; Eugene Braunwald, MD; C. Michael Gibson, MS, MD

From the Cardiovascular Division (H.V.B., S.A.M., C.M.G.), Department of Medicine, University of California San Francisco; Department of Medical Affairs (H.V.B.), Genentech Inc, South San Francisco, Calif; and Department of Medicine, Brigham & Women’s Hospital (C.P.C., E.B.), Boston, Mass.

Correspondence to C. Michael Gibson, MS, MD, Cardiology, University of California San Francisco, 3333 California St, Suite 430, San Francisco, CA 94118.

Background—Elevation of the white blood cell (WBC) count during acute myocardial infarction (AMI) is associated with adverse outcomes. We examined the relationship between the WBC count and angiographic findings to gain insight into this relationship.

Results and Methods—We evaluated data from 975 patients in the Thrombolysis In Myocardial Infarction (TIMI) 10A and 10B trials. Patients with a closed artery at 60 and 90 minutes had higher a WBC count than patients with an open artery (P=0.02). Likewise, the presence of angiographically apparent thrombus was associated with a higher WBC count (11.5±5.2x10⁹/L, n=290, versus 10.7±3.5x10⁹/L, n=648; P=0.008). In addition, a higher WBC count was associated with poorer TIMI myocardial perfusion grades (4-way P=0.04). Mortality rates were higher in patients with a higher WBC count (0% for WBC count 0 to 5x10⁹/L, 4.9% for WBC count 5 to 10x10⁹/L, 3.8% for WBC count 10 to 15x10⁹/L, 10.4% for WBC count >15x10⁹/L; P=0.03). The development of new congestive heart failure or shock was also associated with a higher WBC count (0% for WBC count 0 to 5x10⁹/L, 5.2% for WBC count 5 to 10x10⁹/L, 6.1% for WBC count 10 to 15x10⁹/L, 17.1% for WBC count >15x10⁹/L; P<0.001), an observation that remained significant in a multivariable model that adjusted for potential confounding variables (odds ratio 1.21, P=0.002).

Conclusions—Elevation in WBC count was associated with reduced epicardial blood flow and myocardial perfusion, thromboresistance (arteries open later and have a greater thrombus burden), and a higher incidence of new congestive heart failure and death. These observations provide a potential explanation for the higher mortality rate observed among AMI patients with elevated WBC counts and helps explain the growing body of literature that links inflammation and cardiovascular disease.

Key Words: myocardial infarction • blood flow • mortality • blood cells • heart failure

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