In ACS, White Blood Cell Count Affects the Risk of Ischemic Events

The association between white blood cell (WBC) count and the risk of an ischemic event is significant in both the short and long term among patients with acute coronary syndrome (ACS), according to a new post-hoc analysis of the ATLAS ACS2-TIMI 51 trial. 

Meanwhile, patients with ACS who have a higher WBC count at baseline have an increased risk of a bleeding event in the short term but not in the long term.

To analyze the association between WBC count and the occurrence of short- and long-term bleeding and ischemic events, the researchers evaluated data on 14,231 participants in the ATLAS ACS2-TIMI 51 trial who had had their WBC counts measured at baseline. 

The researchers assessed for associations between WBC count at baseline and a composite outcome of thrombolysis in myocardial infarction (TIMI) major and minor bleeds at 30 days and 1 year. The association between WBC count and a composite ischemic endpoint of cardiovascular death, myocardial infarction, and stroke was also evaluated.

At 30 days, there was increased risk of bleeding per a 1 × 10⁹/L increase in WBC at baseline. The association was not present at 1 year.

However, at both 30 days and 1 year, there was an increased risk of ischemia per a 1 × 10⁹/L increase in WBC at baseline.

—Colleen Murphy

Reference:

Alkhalfan F, Nafee T, Yee MK, et al. Relation of white blood cell count to bleeding and ischemic events in patients with acute coronary syndrome (from the ATLAS ACS 2-TIMI 51 Trial). Am J Cardiol. 2020;125(5):661-669. https://doi.org/10.1016/j.amjcard.2019.12.007.