Comparison of white blood cell counts in acute myocardial infarction patients with significant versus insignificant coronary artery disease.

T possible association between coronary artery spasm and leukocytosis has not been previously investigated for patients with acute myocardial infarction (AMI) and insignificant coronary artery disease (CAD). The goals of this investigaton were to: (1) assess the clinical characteristics and the incidence of inducible coronary vasospasm amongst Taiwanese patients with AMI and insignificant CAD; (2) discuss the possible relation between coronary artery spasm and the patient’s white blood cell (WBC) count regarding the development of AMI; (3) describe the prognosis for these patients; and (4) compare the characteristics of and prognosis for these patients with corresponding characteristics and prognosis for patients with AMI and CAD. • • • From June 1998 to June 2002, cardiac catheterization was performed in a single medical center for 309 consecutive patients with AMI. Of these patients, 36 (12%) with AMI and insignificant CAD were included in this report. Diagnosis of AMI was based on the patient’s condition satisfying 2 of these criteria: (1) chest pain suggestive of myocardial ischemia lasting 30 minutes; (2) enzymatic evidence of acute myocardial necrosis (elevated serum creatine kinase levels of a value at least twice the normal value with an elevated creatine kinase-MB isoenzyme of 5%; (3) new electrocardiographic changes, which included the development of Q waves and/or ST-T changes lasting for a period of 48 hours. In our catheterization laboratory registry, we identified an ageand gendermatched control group that had AMI and significant CAD. Patient clinical records were reviewed for cardiac risk factors, including body mass index, cigarette smoking habits, diabetes mellitus status, and details regarding hypercholesterolemia and hypertension status. A patient’s history of smoking was assessed by asking patients if they had ever smoked 10 cigarettes/day for at least a 1-year period during their lifetime; such a criterion constituting patient classification as a smoker. Diabetes was considered to be present if the patient received dietary treatment, medical therapy, or both for such a condition. Hypercholesterolemia was considered to be present if a patient’s serum total cholesterol level was 240 mg/dl. Systemic hypertension was considered to be present if the patient received medical therapy for such a condition or if the patient exhibited blood pressure 140/90 mm Hg. The WBC counts were obtained by staff in the emergency department after taking a patient’s history and performing an initial evaluation. Cardiac catheterization was performed from 3 to 7 days subsequent to admission for patients with AMI who demonstrated a stable hemodynamic status to evaluate the severity of CAD and to determine the From the Cardiology Section, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. Dr. Cherng’s address is: Cardiology Section, Department of Medicine, Chang Gung Memorial Hospital, 222 Mai-Chin Road, Keelung 204, Taiwan. E-mail: ruby800@cgmh.org.tw. Manuscript received November 14, 2002; revised manuscript received and accepted February 24, 2003. TABLE 1 Clinical Characteristics of Patients With Acute Myocardial Infarction (AMI)