Acute coronary syndrome is one of the most
significant contributors to cardiovascular morbidity
and mortality.[
11] Inflammation plays a significant role
in the development of ACS, according to a study.[
12]
In this study, a direct correlation was observed
between an increase in the WBC, particularly
neutrophil count, at the time of diagnosis and
during follow-up and adverse clinical outcomes in
patients presenting to our emergency department
due to STEMI. Adverse clinical outcomes were
characterized as mortality, recurrent infarction,
and CVD. In our study, the neutrophil count was
significantly higher in those who were older and had high KC scores and creatinine levels. Patients
with adverse clinical outcomes were older and
had higher KC scores. In this group of patients,
the neutrophil count was significantly elevated at
the time of diagnosis and throughout the short
follow-up period. Similarly, when it comes to their
relationship with mortality, mortality was higher in
those with high neutrophil counts, KC scores, and
creatinine.
Acute myocardial infarction (AMI) is a systemic
inflammatory disease triggered by acute inflammation.
The severity of inflammation correlates with the extent
of myocardial infarction. In patients with elevated
WBC and neutrophil counts during the course of
AMI, a larger infarct size was observed.[13] In the study
conducted by Tavares et al.,[14] individuals with higher
neutrophil ratios were found to be older, had higher KC
scores, had a higher rate of smoking, exhibited more
impaired renal function, and experienced a higher rate
of hospitalization for all causes. On the other hand,
according to a study comparing neutrophil counts and
infarct size in patients with AMI, individuals with
high neutrophil counts at admission statistically had
a significantly larger infarct area.[15] In another study
involving 363 patients with AMI, it was observed that
individuals with high neutrophil and WBC counts had
significantly more extensive infarct areas along with a
higher incidence of adverse cardiac endpoints.[16] In our
study, adverse clinical outcomes were more prevalent
in elderly patients and those with KC scores of III-IV.
Similar to the study conducted by Mello et al.,[17]
it was observed that mortality rates increased with
higher KC scores and age following ACS. The reason
for the association between elevated neutrophil counts
post STEMI and adverse clinical outcomes may be
attributed, as demonstrated in previous studies, to the
role of leukocytes, particularly neutrophils, in plaque
rupture, reperfusion injury, and remodeling processes
in ACS.[18] Furthermore, neutrophils may trigger
the occurrence of reinfarction by facilitating platelet
neutrophil interactions, thrombus formation, and the
continuation of coagulation through the membrane
attack complex-1 (CD11b-CD18) pathway.[19] The
high neutrophil percentage may also be independently
associated with damage occurring in microvascular
perfusion. Interactions between neutrophils, platelets,
and endothelium in ACS can also lead to cytokine
release, which may contribute to microvascular
dysfunction.[20] In a study involving 160 patients
with non-ST-elevation ACS, it was found that cases
with high neutrophil counts upon admission to
the hospital had a statistically higher incidence of
death, acute heart failure, and recurrent myocardial
infarction.[21] In our study, patients in the group with
high neutrophil counts had higher creatinine levels and
lower GFR. Similar to our study, in a study conducted,
impaired renal function resulted in increased mortality
and prolonged intensive care unit stay in patients
undergoing reperfusion therapy after STEMI.[22]
The most significant limitation of the study is
the small number of participants. Additionally, two
different reperfusion strategies were applied to the
patients. Pharmacological reperfusion was attained
through the administration of thrombolytic therapy,
whereas mechanical reperfusion was achieved through
primary percutaneous coronary intervention. These
two methods have different effects on systemic
inflammation. In our study, the majority of patients
underwent primary percutaneous coronary intervention
treatment.
In conclusion, a correlation was determined
between WBC and neutrophil counts and the rates of
in-hospital mortality and adverse clinical consequences
in individuals presenting with acute STEMI. There
are numerous studies conducted on the WBC count
in patients diagnosed with ACS, including AMI.
However, the number of studies examining the
relationship between neutrophil count and adverse
clinical outcomes is limited. Elevated neutrophil count
assessed upon admission to the hospital and during
short-term follow-up may be utilized to identify highrisk
patients.
Ethics Committee Approval: The study protocol
was approved by the Eskişehir Osmangazi University
Faculty of Medicine Ethics Committee (date: 21.05.2010,
no: PR-10-03-19-09). The study was conducted in accordance
with the principles of the Declaration of Helsinki.
Patient Consent for Publication: A written informed
consent was obtained from each patient.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Idea/concept, data collection and/
or processing, literature review, writing the article, critical
review, references and fundings, materials: M.İ.D.; Design,
control/supervision, analysis and/or interpretation: M.İ.D.,
A.Ü.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.
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