Assessment of differential leukocyte count in patients with acute coronary syndrome

Objective: To assess the predictive ability of leukocyte subtypes for mortality in patients with acute coronary syndrome (ACS). Methods: One hundred and thirty three consecutive patients of ACS were assessed in the study and were followed up for one year. Diagnosis was based on clinical characteristics and the laboratory data. The total leukocytes and its subtypes were counted by Sysmex automated cell counter. The predictive ability for death of total count of leukocytes, neutrophils, lymphocytes and monocytes was assessed using Cox regression analysis. Results: Univariate analysis revealed higher prevalence of total leukocytes (HR= 1.001, p= 0.001) and its subtypes, neutrophils (HR 1.001, p= 0.001) and monocytes (HR 1.006, p= 0.001), in patients of ACS. In multivariate modeling, after entering standard coronary risk factors, count of total and differential leukocytesneutrophils, lymphocytes, monocytes and cardiac biomarkers CK-MB, Trop I; the monocyte count (hazard ratio [HR] 1.004, CI 1.002-1.006, p 0.0001) was found to be independent predictor for ACS. A significance correlation between monocyte count and CK-MB, representing extent of myocardial damage, was also seen (r=0.301, p 0.0001). Conclusion: The increase in monocyte count is an independent predictor of death and prognostic marker of the extent of myocardial damage in patients with ACS.