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Impact of baseline hemoglobin level and white blood cell count in real-world patients undergoing contemporary percutaneous coronary intervention: insights from the GLOBAL LEADER study

Session Optimal treatment of coronary artery disease

Speaker Ply Chichareon

Congress : ESC Congress 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease and Comorbidities
  • Session type : Abstract Session
  • FP Number : 3331

Authors : P Chichareon (Amsterdam,NL), R Modolo (Amsterdam,NL), M Tomaniak (Rotterdam,NL), N Kogame (Amsterdam,NL), G Fontos (Bonyhad,HU), P Lantelme (Lyon,FR), P Barraud (Clermont Ferrand,FR), C Hamm (Bad Nauheim,DE), G Steg (Paris,FR), P Juni (Toronto,CA), P Vranckx (Hasselt,BE), M Valgimigli (Bern,CH), S Windecker (Bern,CH), Y Onuma (Rotterdam,NL), PW Serruys (London,GB)

P Chichareon1 , R Modolo1 , M Tomaniak2 , N Kogame1 , G Fontos3 , P Lantelme4 , P Barraud5 , C Hamm6 , G Steg7 , P Juni8 , P Vranckx9 , M Valgimigli10 , S Windecker10 , Y Onuma2 , PW Serruys11 , 1Amsterdam University Medical Center, Cardiology - Amsterdam - Netherlands (The) , 2Erasmus University Medical Centre - Rotterdam - Netherlands (The) , 3Gottsegen Gyorgy Hungarian Institute of Cardiology - Budapest - Hungary , 4Hospital La Croix-Rousse - Hcl - Lyon - France , 5Clinique des Domes - Clermont Ferrand - France , 6Kerckhoff Heart and Thorax Center - Bad Nauheim - Germany , 7Hospital Bichat-Claude Bernard - Paris - France , 8St. Michael's Hospital - Toronto - Canada , 9Virga Jesse Hospital - Hasselt - Belgium , 10Preventive Cardiology & Sports Medicine, Inselspital Bern - Bern - Switzerland , 11Imperial College London - London - United Kingdom of Great Britain & Northern Ireland ,


The impact of hemoglobin (Hb) level and white blood cell count (WBC) on the outcomes in all-comers PCI patients is unknown.


We sought to assess the association between baseline Hb level, WBC count on 2-year outcomes after PCI in all-comers patients in the GLOBAL LEADERS study.  We compared the outcomes between anemic and non-anemic patients according to WHO definition.


GLOBAL LEADERS study assessed the efficacy and safety of two antiplatelet strategies in 15,991 patients undergoing PCI. The primary endpoint was all-cause mortality or new Q wave myocardial infarction (MI) at 2 years. Secondary safety endpoint was BARC 3 or 5 bleeding at 2 years.

The association between WBC count, Hb level and outcomes at 2 years were assessed in the multivariable Cox model adjusted for age, diabetes, ejection fraction and renal impairment. For Hb level, patients were categorized according to the WHO definition of anemia (Hb < 12 g/dL in women, Hb < 13 g/dL in men).


Of 15991 patients randomized in the GLOBAL LEADER study, baseline WBC count and Hb levels were available in 14960 (93.7%) patients and 15215 (95.3%) patients, respectively.

Hb level had an inverse association with adverse events after PCI. In the multivariable Cox model, Hb level was an independent predictor for ischemic and bleeding outcomes at 2 years while the WBC count was not (see table).

Compared with non-anemic patients, anemic patients had significantly higher risk of primary endpoint (adjusted HR 2.07, 95% CI 1.72-2.49), BARC 3 or 5 bleeding (adjusted HR 1.49 95% CI 1.14-1.96), all-cause mortality (adjusted HR 2.33, 95% CI 1.89-2.86), any MI (adjusted HR 1.41, 95% CI 1.11-1.80), and any revascularization (adjusted HR 1.20, 95% CI 1.03-1.39).


In the all-comers patients undergoing PCI, the baseline Hb level was significantly associated with the ischemic and bleeding outcomes at 2 years whereas baseline WBC count was not. Baseline WBC count may not be useful as a prognostic factor after PCI.

Outcomes at 2 years

Hemoglobin level (mg/dL)

WBC count (10^9/L)

HR (95% CI)

P value

HR (95% CI)

P value

All-cause mortality or new Q wave MI

0.87 (0.82-0.91)

< 0.0001

1.00 (0.999-1.002)


All-cause mortality

0.82 (0.78-0.87)

< 0.0001

1.00 (0.999-1.002)


Any myocardial infarction

0.93 (0.87-0.99)


1.00 (0.996-1.001)


Any revascularization

0.96 (0.93-1.00)


1.00 (1.00-1.001)


BARC 3 or 5 bleeding

0.85 (0.79-0.91)

< 0.0001

1.00 (0.997-1.002)


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