Assessment of differential leukocyte count in patients with acute coronary syndrome (original) (raw)

2010, Journal of the Pakistan Medical Association

Inflammation, dyslipidaemia, hyperglycaemia, hypertension, endothelial lesions, smoking, genetic predisposition and activation of immune system cells play an important role in the pathogenesis of atherosclerosis (AS). 1 Various inflammatory markers are suggestive of coronary artery disease (CAD) and have been proposed for evaluation of cardiovascular risk. These inflammatory markers include C-reactive protein (CRP), tumour necrosing factor-alpha (TNF-α), fibrinogen, homocysteine and white blood cells count (WBCs). 2 White blood cells help to assess the adaptive, maladaptive, acute and chronic inflammatory status while elevated WBC count is associated with high short term and long term mortality, more serious AS, and a lower response to fibrinolytic treatment in patients with acute coronary syndrome (ACS). 3 Recent data has also revealed that some specific subtypes of leukocytes have higher predictive value in assessing the cardiovascular risk. 4 Various studies have shown that neutrophils are involved in adaptive infarct healing, leukocyte-platelet aggregate formation and a cause of reperfusion injury in acute coronary syndromes. On the other hand monocytes and lymphocytes are considered to be prevalent and pathogenic in unstable coronary artery plaques. 1 This study was designed to evaluate the predictive value of WBC and its elements in patients of ACS in local Pakistani population where lack of resources keep the access of so many to the best available diagnostic methods. WBC elements may become an additional parameter for the preliminary approach of patients with ACS. This study was approved by institutional review board and ethics committee on human research. Patients and Methods Sixty nine healthy subjects and 133 patients of ACS were included in the study by using convenience sampling technique. All patients were evaluated by taking detailed history and physical examination. The variables included in the study were age, sex, diabetes mellitus (DM), systolic and diastolic hypertension, hyperlipidaemia, smoking, family history of ischaemic heart disease (IHD), cardiac biomarkers (Troponin I, CK-MB), C-reactive protein (CRP), and the total and differential leukocyte counts. The inclusion criteria for the patients of ACS were those of American College of Cardiology and European Society of Cardiology. 5 The criteria for STEMI were as follows: an increase in the levels of myocardial necrosis (troponin I >1 ng/ml); new ST elevation from the J point in two or more contiguous leads