Predictive value of in-hospital white blood cell count in Chinese patients with triple-vessel coronary disease

The predictive value of white blood cells in triple-vessel coronary artery disease (TVD) remains unclear. This study aimed to examine the relationship between WBC counts and long-term prognosis of TVD.

A total of 8943 consecutive patients with triple-vessel coronary artery disease were enrolled from April 2004 to February 2011. The primary endpoint was all-cause death and the secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs; a composite of all-cause death, myocardial infarction or stroke).

After a median of 7.5 years of follow-up, 7678 patients were included in the final analysis. Multivariable analysis showed that the white blood cell count was an independent predictor of death (hazard ratio: 1.04, p < 0.01) and MACCE (hazard ratio: 1.03, p = 0.02). In white blood cell differential analysis, increased monocytes (hazard ratio: 1.93, p = 0.001) and eosinophils (hazard ratio: 1.82, p < 0.01), and decreased lymphocytes (hazard ratio: 0.89, p = 0.02) were independent predictors of death. Increased monocytes (hazard ratio: 1.62, P = 0.002) and eosinophils (hazard ratio: 1.55, p < 0.01) were independent predictors of MACCE. A combination of monocyte, lymphocyte and eosinophil counts with the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score improved the predictive value for mortality (area under the curve from 0.569 to 0.611; integrated discrimination improvement = 0.012; net reclassification improvement = 0.299) and improved slightly with SYNTAX score II (all p < 0.05).

Total and differential white blood cell counts are independent prognostic factors of long-term mortality and MACCE in triple-vessel coronary artery disease. A combination of monocyte, lymphocyte and eosinophil counts improved the predictive value for mortality with the SYNTAX score, and improved it slightly with SYNTAX score II.