JOURNAL READING

Routinely Analyzed Leukocyte

Characteristics Improve Prediction of
Mortality After Coronary Angiography
Supervisor :
dr. H. M. Saugi Abduh, Sp.PD (KKV)

Student:
[Name]
[NIM]

I N T E R N A L M E D I C I N E D E PA R T M E N T
S U LTA N A G U N G I S L A M I C H O S P I TA L
 Journal Identity
TITLE
• Routinely analyzed leukocyte characteristics improve prediction
of mortality after coronary angiography
AUTHOR
• Crystel M Gijsberts1,2, Guilielmus HJM Ellenbroek1,
• Maarten J ten Berg3, Albert Huisman3, Wouter W van Solinge3,
Folkert W Asselbergs4,5,6, Hester M den Ruijter1,
• Gerard Pasterkamp1,3, Dominique PV de Kleijn1,2,7,8 and Imo E 80%
Hoefer1,3
PUBLISHER
• European Journal of Preventive Cardiology 2015
 Background
Inflammation and
hallmarks of
leukocyte
atherosclerosis
infiltration

Clinically routine perform an

hematology entire differential
analyzers blood count
coronary artery
We hypothesize that unreported disease
leukocyte characteristics (CAD) in coronary
severity angiography
associate with improve patients.
prediction of
mortality
CAD severity was categorized into :
• no/minor CAD
• single-vessel disease
• double-vessel disease
• triple- vessel disease

• (according to the number of epicardial vessels with a stenosis of > 50%, as visually assessed
by the interventional cardiologist).
SYNTAX score
• In patients with significant CAD (i.e. one or more vessels with > 50% stenosis)
• and without history of CABG,
• a synergy between PCI with taxus and cardiac surgery (SYNTAX) score was measured (n ¼
603).
• This was performed by two independent observers with unlimited access to quantitative
coronary angiography analysis.

• When scores differed by > 5 points between the two observers (n ¼ 131), cases were
discussed in order to reach consensus.
• The mean of the SYNTAX scores of the two observers was used for analysis.
Leukocyte characteristics
• Parameters that were used in this study comprised UPOD leukocyte parameters:
• leukocyte,
• neutrophil,
• monocyte and lymphocyte counts and percentages,
• neutrophil cell size (mean and coefficient of variation (CV)) and complexity (mean
and CV)
• lymphocyte cell size (mean and CV) and complexity (mean and CV).

Three leukocyte ratios were calculated

• Neutrophile-to-lymphocyte ratio (NLR)
• monocyte-to-lymphocyte ratio (MLR)
• lymphocyte-to-monocyte ratio (LMR)
• as these ratios had been previously reported in the context of (cardiovascular)
mortality prediction.
 METHOD
We studied coronary angiography patients suspected of CAD (n ¼ 1015)
from the Utrecht Coronary Biobank cohort

Leukocyte characteristics were routinely assessed in blood drawn

directly prior to angiography using an auto- mated hematology
analyzer and extracted from the Utrecht patient oriented database
(UPOD) database

Patients were followed up for a median duration of 805 days, during

which 65 patients died

We evaluated the association of leukocyte characteristics with

synergy between PCI with taxus and cardiac surgery (SYNTAX) score as
a measure of CAD severity, all-cause and cardiovascular mortality and
major adverse cardiovascular events (MACEs).

In order to determine the improvement of risk prediction, we

calculated continuous net reclassification improvement (cNRI) and
integrated discrimination improvement (IDI).
 All patients aged > 18 years

undergoing coronary angiography

INCLUSION
for any indication :
stable angina, unstable angina,
myocardial infarction or other indication
at the University Medical Centre in Utrecht (UMCU)
between October 2010 and April 2013.

Patients are followed up for 5 years, of which 3 years had passed at

the moment of writing.
DISCUSSION
A non-parametric test was performed for comparison between the groups for
SYNTAX score and hsCRP
Monocyte percentage showed strong independent predictive value for
all-cause mortality (hazard ratio (HR) 1.44 (1.19–1.74), p < 0.001)
the monocyte-to-lymphocyte ratio performed best for cardiovascular mortality
(HR1.42 (1.11–1.81), p ¼ 0.005)
 RESULTS The cNRIs and IDIs of
Monocyte leukocyte
percentage characteristics for all-
showed strong cause mortality
independent monocyte-to-lymphocyte confirmed the
predictive value ratio performed best for improvement in
for all-cause cardiovascular mortality mortality risk
mortality prediction

hazard ratio (HR) hazard ratio (HR)

1.44 (1.19–1.74), p < 0.001) 1.42 (1.11–1.81), p ¼ 0.005)

No significantly predictive
leukocyte characteristics were
found for MACEs
 CONCLUSION
Readily available yet unreported
leukocyte characteristics from routine hematology
analyzers significantly improved
prediction of mortality
in coronary angiography patients
on top of clinical characteristics
 Limitations

The main limitation of this study is

the limited number of
(cardiovascular) deaths during
follow-up.
THANKYOU!