TY - JOUR
T1 - Effect of leukocytosis at initial examination on prognosis in patients with primary unstable angina
AU - Lloyd-Jones, Donald M.
AU - Camargo, Carlos A.
AU - Giugliano, Robert P.
AU - O'Donnell, Christopher J.
N1 - Funding Information:
From the Tordrology Division, Deportment of Medicine, and the Deportment of Emergency Medicine, Massachusetts Generol Hospital, and Thawing Laboratory ond Cardiovascular Division, Deportment of Medicine, Brigham and Women’s Hospital, Harvard Medical School; and the eNationol Heart, lung, and Blood Instl-t&e’s Framinghorn Heart Study. Supported by grant Ht.03533 (Or Comargoj and grant Hl-07575 (Or GiuglianoJ from the Notional Institutes of Health, Bethesda, Md. Submitted August 12, 1999; accepted November 23, 1999. Reprint requests: Donald M. Lloyd-Jones, MD, Framinghorn Heart Study, 5 Thurber St, Framingham, MA 0 1702. E-Mall: don@fram.nhlbt.nih.gov Copyright 0 2000 by Mosby, Inc. 0002.8703/2000/$12.00+ 0 4/I/104763 doi: IO. 1067/mh;.2000.104763
PY - 2000/5
Y1 - 2000/5
N2 - Background: Leukocytosis with acute myocardial infarction at initial examination predicts adverse prognosis, but it is unknown whether it predicts outcome in patients with primary unstable angina. Methods and Results: We studied 414 consecutive patients with unstable angina admitted through the emergency department to telemetry and intensive care units of an urban academic hospital. To study primary unstable angina, we excluded 134 patients with precipitants (eg, urosepsis, pneumonia) that may cause leukocytosis. Of 280 patients, 96 (34%) had leukocytosis (leukocyte count > 10,000 per μL) at initial examination. A total of 30 patients (11%) died and 47 (17%) died or had nonfatal myocardial infarction within 12 months of initial examination. In a univariate Cox model, patients with leukocytosis had a hazard ratio (HR) of 2.6 (95% confidence interval [CI] 1.3-5.4) for death by 1 year. In a multivariate Cox model the only significant predictors of 1-year death were congestive heart failure at initial examination (HR 7.8; 95% CI 2.8-22) and elevated creatinine (HR 2.7; 95% CI 1.3-5.7); in this model, the relation between leukocytosis and prognosis was markedly attenuated (HR 1.4; 95% CI 0.6-2.9). The adjusted HR for leukocytosis was 1.3 (95% CI 0.72.3) for death or nonfatal MI by 1 year. Conclusions; Leukocytosis at initial examination is associated with adverse prognosis in patients with primary unstable angina. However, the association is confounded by other important predictors of prognosis. Leukocytosis may be a marker of stress associated with more severe cases of unstable angina or comorbid conditions.
AB - Background: Leukocytosis with acute myocardial infarction at initial examination predicts adverse prognosis, but it is unknown whether it predicts outcome in patients with primary unstable angina. Methods and Results: We studied 414 consecutive patients with unstable angina admitted through the emergency department to telemetry and intensive care units of an urban academic hospital. To study primary unstable angina, we excluded 134 patients with precipitants (eg, urosepsis, pneumonia) that may cause leukocytosis. Of 280 patients, 96 (34%) had leukocytosis (leukocyte count > 10,000 per μL) at initial examination. A total of 30 patients (11%) died and 47 (17%) died or had nonfatal myocardial infarction within 12 months of initial examination. In a univariate Cox model, patients with leukocytosis had a hazard ratio (HR) of 2.6 (95% confidence interval [CI] 1.3-5.4) for death by 1 year. In a multivariate Cox model the only significant predictors of 1-year death were congestive heart failure at initial examination (HR 7.8; 95% CI 2.8-22) and elevated creatinine (HR 2.7; 95% CI 1.3-5.7); in this model, the relation between leukocytosis and prognosis was markedly attenuated (HR 1.4; 95% CI 0.6-2.9). The adjusted HR for leukocytosis was 1.3 (95% CI 0.72.3) for death or nonfatal MI by 1 year. Conclusions; Leukocytosis at initial examination is associated with adverse prognosis in patients with primary unstable angina. However, the association is confounded by other important predictors of prognosis. Leukocytosis may be a marker of stress associated with more severe cases of unstable angina or comorbid conditions.
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U2 - 10.1016/S0002-8703(00)90019-X
DO - 10.1016/S0002-8703(00)90019-X
M3 - Article
C2 - 10783221
AN - SCOPUS:0034069182
VL - 139
SP - 867
EP - 873
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
IS - 5
ER -