J Cardiovasc Thorac Res, 2014, 6(1), 35-41

doi: 10.5681/jcvtr.2014.007 TUOMS

Publishing
http://journals.tbzmed.ac.ir/jcvtr Group

Research Article

The Predictive Value of Total Neutrophil Count and Neutrophil/

Lymphocyte Ratio in Predicting In-hospital Mortality and
Complications after STEMI
Samad Ghaffari1, Mehdi Nadiri2, Leili Pourafkari1, Nariman Sepehrvand1, Aliakbar Movasagpoor1, Neda Rahmatvand1,
Mohammadamin Rezazadeh Saatloo1, Mona Ahmadi1, Nader D Nader3*
1
Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2
Tohid Hospital, Sanandaj, Iran
3
VA Western New York Healthcare System, University of Buffalo, Buffalo, USA

Article info Abstract

Article History: Introduction: Leukocytosis, predominantly neutrophilia, has previously been described following
Received: 7 June 2013 ST elevation myocardial infarction (STEMI). The exact contribution of this phenomenon to the
Accepted: 2 January 2014 clinical outcome of STEMI is yet to be shown. We examined cellular inflammatory response to
STEMI in the blood and its association with in-hospital mortality and/or adverse clinical events.
Methods: In this cross-sectional study, 404 patients who were admitted with the diagnosis of
acute STEMI at Madani Heart Hospital from March 2010 to March 2012 were studied. The
Keywords: complete blood cell count (CBC) was obtained from all patientswithin12-24 hours of the onset
Acute Myocardial Infarction
of symptoms. Total leukocytes were counted and differential count was obtained for neutrophils,
ST Segment Elevation
White Blood Cell
lymphocytes and neutrophil/lymphocyte ratio (NLR) were evaluated. Association of cellular
Total Neutrophil Count response with the incidence of post-MI mortality/complications was assessed by multiple logistic
Neutrophil/Lymphocyteratio regression analyses.
Results: In-hospital mortality and post-STEMI complication rate were 3.7% and 43.6%,
respectively. Higher age (P=0.04), female gender (0.002), lower ejection fraction (P<0.001) and
absolute neutrophil count (P=0.04) were predictors of mortality. Pump failure in the form of
acute pulmonary edema or cardiogenic shock occurred in 35 (8.9%) of patients. Higher leukocyte
(P<0.03) and neutrophil counts (P<0.03) and higher NLR (P=0.01) were predictors of failure. The
frequency of ventricular tachyarrhythmias (VT/VF) at the first day was associated with higher
neutrophil count (P<0.001) and higher NLR level (P<0.001). In multivariate analysis neutrophil
count was an independent predictor of mortality (OR=2.94; 1.1-8.4, P=0.04), and neutrophil
count [OR=1.1, CI (1.01-1.20), P=0.02], female gender [OR=2.34, CI (1.02-4.88), P=0.04] and
diabetes [OR=2.52, CI (1.21-5.2), P=0.003] were independent predictors of heart failure.
Conclusion: A single CBC analysis may help to identify STEMI patients at risk for mortality and
heart failure, and total neutrophil count is the most valuable in predicting both.

Introduction blood. Various clinical trials have reported an association

The relationship between inflammation and myocardial between increased neutrophil count in peripheral blood
infarction (MI) was suggested more than 50 years ago.1 and short-term post-MI adverse outcomes and worse
Since then, overwhelming evidences supporting this angiographic findings.11-13 Also, there are some reports
relationship have been obtained from various basic regarding the value of monocyte count in predicting heart
sciences, epidemiological and clinical studies.2-4 failure following MI.14,15
Determining peripheral leukocyte count is an inexpensive Amongst different hematological indices, it has been
and widely available way to assess the presence of any shown that the neutrophil/ lymphocyte ratio (NLR) has
inflammation. According to the literature, MI is usually the highest predictive value in predicting death/MI in
accompanied with peripheral leukocytosis5 and the high risk patients for coronary artery disease.16 Also, it
leukocytosis is associated with higher rates of short-term has been shown that NLR predicts the long term mortality
mortality and heart failure after myocardial infarction.6-10 in patients hospitalized with ST elevation myocardial
Neutrophils are the major leukocytes in the peripheral infarction (STEMI)17, and in patients undergoing

*Corresponding author: Nader D Nader, Email: [email protected]

© 2014 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.
org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ghaffari et al.

percutaneous coronary intervention (PCI).18,19 Median (range) for continuous variables and frequency
Since neutrophils and lymphocytes act in immunologically (%) for dichotomous or discrete variables. Chi square
different patterns18, this study aimed at evaluating the test and fisher’s exact test were used for comparing
predictive value of total peripheral neutrophil count and categorical variables. Wilcoxon Rank test was used to
NLR in determining the prognosis of MI and the risk compare the numerical data since the data did not have
of major post-MI adverse events. We hypothesized that a normal distribution. Multivariate logistic regression
patients with high leukocytic response and NLR were at was performed to study the role of different factors in
higher risk of in-hospital death and complications after a predicting adverse post-MI events. Receiver operating
documented STEMI. characteristics (ROC) curves and Area under the curve
(AUC) were used in order to determine the cutoff points
Materials and methods for the cell count, and NLR in predicting mortality and
In this descriptive cross-sectional study that was approved major complications. Then, the sensitivity, specificity,
by the Scientific & Ethical Review Board of Tabriz positive and negative preventive values, positive and
University of Medical Sciences, four hundred and four negative likelihood ratio were calculated for each index.
patients admitted with acute STEMI in the CCU of Madani Any relationship between WBC subgroups and LVEF
Heart Hospital, Tabriz- Iran from March 2010 to March were analyzed using Pearson correlation test. P<0.05 was
2012, were enrolled after obtaining an informed written considered statistically significant.
consent. Patients with active inflammation or chronic
inflammatory diseases, past history of surgery within 3 Results
months prior to MI, and cancer were excluded from the Patient characteristics
study. STEMI was determined using the definition and Four hundred and four patients with acute SETMI were
criteria provided by American College of Cardiology evaluated in this study. 81.2% (328 Cases) of patients
(ACC) and European Society of Cardiology; In short: were male with the mean age of 58.9±12.9 years. Positive
STEMI defined as an increase in cardiac troponin-I familial history for coronary artery disease was present in
(cTNI) along with new ST-segment elevation measured 87 (21.5%), hyperlipidemia in 114 (28.2%), Hypertension
from J point at least 0.2 mV in two adjacent V1-V3 leads in 157 (38.9%), DM in 101 (25%), Current smoking in 180
or at least 0.1 mV in other leads within 24 hours after the (44.6%) and previous coronary revascularization in the
onset of chest pain. form of either coronary artery bypass grafting (CABG)
Complete blood cell count (CBC) was performed in all or percutaneous coronary angioplasty (PTCA) in 12
patients within 12-24 hours of onset of symptoms. This subjects (3.0%) was detected. The laboratory findings
was based on the findings of Nunez et al. which showed were presented in Table 1.
higher neutrophil and a relatively lower lymphocyte
counts resulting in excessive NLR in this time period.17 Electrocardiographic findings
After sampling, blood samples were evaluated for total Myocardial infarction was determined to be inferior
WBC count, neutrophil, lymphocytes (LYM), and NLR wall MI in 184 (45.5%) and anterior MI in remaining
using CBC H1 machine. The information regarding 220 (54.5%) cases. A total of 176 patients (43.6%)
demographic features, past medical history, patient’s demonstrated electrical complications of MI. Ventricular
outcome and the occurrence of major complications or tachyarrhythmias (VF/VT) were seen in 37 subjects
mortality were collected from the medical records for all (29 in the first day and 8 cases thereafter), left bundle
subjects. branch block (LBBB, 14 cases), right bundle branch block
Hypertension was defined as blood pressure of (RBBB, 40 cases), atrial fibrillation (20 cases), paroxysmal
≥140/90 mmHg recorded at least two times or current
antihypertensive therapy. Diabetes was defined as Table 1. Laboratory findings
fasting plasma glucose of>126 mg/dL for at least two
Median
measurements or current glucose lowering treatment Lab tests Mean±SD
(95% CI Range)
as defined by the World Health Organization.
Creatine kinase (total) 1,494±90 860 (25-13,700)
Hyperlipidemia was defined as total cholesterol of >200
Creatine kinase (MB fraction) 153±9 82.5 (3-1,008)
mg/dL or a history of elevated serum total cholesterol
during the previous 6 months resulting in prescription of Cardiac Troponin I (cTnI) 10.7±1.2 4.0 (0.01-341)
a lipid lowering agent. Primary endpoint was in-hospital White Blood Cells count* 11.1±3.6 10.8(2.2-25.8)
mortality and secondary endpoints included pump failure Neutrophils absolute count* 8.69±3.59 8.36(0.88-23.29)
(defined as cardiogenic shock and/or pulmonary edema) Lymphocytes* 1.49±0.74 1.38(0.10-5.27)
and major tachyarrhythmias (defined as atrial fibrillation
Monocytes* 0.65±0.27 0.62 (0.10-2.46)
and ventricular tachycardia or fibrillation).
Neutrophil/Lymphocyte ratio
8.6±10.5 5.7 (0.1-128.4)
NLR
Statistical Analysis Neutrophil/Monocyte ratio NMR 14.9±9.3 12.5 (2.3-115.2)
All collected data were analyzed using SPSS 18 (SPSS White Blood Cells, Neutrophils, Lymphocytes and Monocytes
Inc., Chicago, IL). Descriptive statistics were reported as were expressed as 1000xcells/mm3)

36 J Cardiovasc Thorac Res, 2014, 6(1), 35-41

Neutrophil/lymphocyte ratio and STEMI

supraventricular tachycardia (PSVT, 6 cases), and a total the sensitivity and specificity of factors in predicting in-
of 30 cases of AV block, first degree (20 cases) and second hospital mortality. The cutoff point of neutrophil >9.68-
degree (4 cases) and third degree (6 cases). x1000 cells/mm3 had a sensitivity of 60% and specificity
of 66.2% in predicting post-MI mortality (Figure 1A,
Angiographic findings AUC=0.65, P=0.04).
The frequency of single vessel disease (1VD), 2VD and
3VD was 38.9%, 31.6%, and 29.5%, respectively. According Analysis for post-STEMI complications
to the angiographic findings, CABG and PCI were We evaluated the frequency of pump failure and atrial
suggested respectively for 29.8% and 46.7% of patients fibrillation or ventricular tachyarrhythmias. Pump failure
and 23.5% of them were candidate for medical follow up. (defined as cardiogenic shock and/or pulmonary edema)
was present in 35 (8.9%) and major tachyarrhythmias
Clinical Outcome (defined as atrial fibrillation, and ventricular tachycardia
Patients were hospitalized for an average of 7.4±4.9 (range or fibrillation) in 20 (5.0%) and 37 (9.2%) patients,
1-35) days. Fifteen patients died during their hospital stay respectively. Patients with pump failure had significantly
(3.7%). Following complications of STEMI occurred in higher total WBC (P<0.03), neutrophil count (P<0.03)
the order of occurrence; more than moderate MR (29 and NLR (P=0.01). There were no significant differences
cases), pulmonary edema (21 cases), cardiogenic shock between total WBC or neutrophil counts and NLR among
(19 cases), pericarditis (7 cases), recurrent MI (4 cases) patients with or without atrial fibrillation and also those
and VSD (2 cases). with VT/VF beyond first day, however, total WBC count;
neutrophil count and NLR were significantly higher
Analysis for post-MI mortality in patients with VT/VF within the first day (Table 3).
Non-surviving patients were generally female (P=0.04), Multivariate analysis showed neutrophil count, female
with advanced age (P=0.002), higher cTnI level (P<0.001) gender and diabetes as independent predictors for
and lower left ventricular ejection fraction (LVEF) development of pump failure (Table 4).
(P<0.001). The mean WBC count and NLR were higher Similar to mortality, patients with a neutrophil count of
among non-survivors compared to survivors but the >9.68×1000 cells/mm3 at the time of admission were found
differences were not statistically significant. However, to have significantly higher rate of VT/VF (P<0.001) and
absolute neutrophil count was significantly higher among pulmonary edema (P=0.03) during the first 24 hours
non-survivors (Table 2). Multivariate analysis revealed compared to those who had a neutrophil count of less
neutrophil count as an independent predictor of mortality than or equal to 9.68×1000 cells/mm3 (Table 5).
[OR=2.94, CI (1.03-8.44), P=0.04]. Subgroups analysis Different WBC indices (WBC and neutrophil count &
of WBC by ROC-analysis was performed to determine NLR) were analyzed by ROC analyses in order to determine

Table 2. Patient variable among the survivors and non-survivors after acute STEMI
Survivors (n=389) Non-Survivors (n=15) P
Age (Mean±STD) 58.7±12.9 65.7±13.4 0.04
Gender (Male) 321(82.5 %) 7(46.7 %) 0.002
Hypertension 148(38.1 %) 9(60 %) 0.10
Diabetes mellitus 95(24.4 %) 6(40 %) 0.22
Hyperlipidemia 109(28.1 %) 5(33.3 %) 0.77
Active Smoking 177(45.5 %) 3(20 %) 0.06
Left Ventricular Ejection Fraction (%) 38±10 27±12 <0.001
Creatine kinase (total) 1,482±497 1815±9,157 0.48
Creatine kinase (MB fraction) 152±9 178±44 0.58
Cardiac Troponin I (cTnI) 9.9±0.9 32.9±22.1 <0.001
White Blood Cells count* 10.7 (10.4-11.1) 13.0 (10.1-15.5) 0.10
Neutrophils absolute count * 8.33 (7.82-8.68) 10.99 (7.76-13.06) 0.04**
Lymphocytesabsolute count * 1.38 (1.31-1.44) 1.37 (1.02-1.72) 0.59
Monocytes absolute count * 0.62 (0.58-0.65) 0.61 (0.51-0.91) 0.66
Neutrophil/Lymphocyte ratio (NLR) 5.64 (5.08-6.20) 8.03 (5.66-11.82) 0.28
Neutrophil/Monocyte ratio (NMR) 12.4 (12.1-13.2) 14.4 (10.8-18.9) 0.54
* Median (95% CI; 103×cells/mm ); 3

** Statistically significant on one-tail analysis only.

J Cardiovasc Thorac Res, 2014, 6(1), 35-41 37

Ghaffari et al.

Figure 1. ROC curves examining various subtypes of peripheral blood leukocytes in predicting in-hospital mortality (A) and complications
(B) after STEMI

Table 3. Total WBC and neutrophil counts, and NLR in patients with and without post-STEMI complications

Complications Parameter Cases with Cases without P

WBC (1000 cells/mm3) 13.2 (11.1-15.6) 10.7 (10.2-11.0) <0.001

VT/VF (29) within 24 hours Neutrophils (1000 cells/mm3) 11.37 (8.58-13.44) 8.25 (7.71-8.60) <0.001

NLR 11.1 (5.7-13.6) 5.5 (5.0-6.2) <0.001

WBC (1000 cells/mm ) 3

12.1 (6.7-15.0) 10.7 (10.4-11.1) 0.63

VT/VF after 24 hours (8) Neutrophils (1000 cells/mm ) 3

10.41 (3.25-12.78) 8.35 (7.86-8.70) 0.54

NLR 8.3 (1.8-14.3) 5.7 (5.1-6.2) 0.93

WBC (1000 cells/mm3) 10.5 (8.7-11.7) 10.8 (10.4-11.1) 0.56

Atrial Fibrillation (20) Neutrophils (1000 cells/mm ) 3

7.85 (6.09-9.86) 8.39 (7.86-8.76) 0.45

NLR 5.1 (3.9-6.5) 5.7 (5.2-6.4) 0.35

WBC (1000 cells/mm3) 11.1 (9.9-13.0) 10.7 (10.4-11.1) 0.23

Cardiogenic Shock (20) Neutrophils (1000 cells/mm3) 8.58 (7.82-10.99) 8.33 (7.76-8.68) 0.19

NLR 8.0 (4.2-11.7) 5.7 (5.1-6.2) 0.25

WBC (1000 cells/mm ) 3

12.8 (11.1-16.4) 10.7 (10.3-11.0) 0.005

Pulmonary Edema (21) Neutrophils (1000 cells/mm3) 10.76 (7.0513.04) 8.30 (7.76-8.61) 0.01

NLR 8.7 (3.7-12.0) 5.7 (5.1-6.2) 0.41

WBC (1000 cells/mm ) 3

12.5 (10.7-13.8) 10.7 (10.3-11.0) 0.03
Pump Failure (35)
Neutrophils (1000 cells/mm ) 3
9.65 (8.26-11.30) 8.27 (7.74-8.66) 0.03

NLR 11.11 (9.4-12.8) 8.0 (7.5-8.5) 0.01

WBC: White Blood Cells; NLR: Neutrophil/Lymphocyte ratio; VT: ventricular tachycardia

38 J Cardiovasc Thorac Res, 2014, 6(1), 35-41

Neutrophil/lymphocyte ratio and STEMI

the sensitivity and specificity of factors in predicting in- count and incidence of cardiogenic shock or congestive
hospital post-MI complications. AUC were significant heart failure.10 They reported a higher mortality in patients
for all of three leukocytic indices of inflammation, but with more intense increase in WBC count. A similar linear
neutrophil count had more sensitivity than other indices correlation was observed between in-hospital mortality
(AUC=0.628, P<0.001, Figure 1B). and increasing white blood cells count in the blood.8
In our study, although there was a higher WBC count
Discussion among non-survivors, the difference was not statistically
In the current study, we evaluated the leukocytic response significant. We postulated that lower in-hospital mortality
to STEMI and examined its possible association with in- rate in our patient population was accountable for this
hospital mortality and post-infarction complications. finding.
We demonstrated that 12-24 hours following STEMI We performed a single CBC analysis to show the value
the numbers of white blood cells, mostly in the form of this inexpensive and widely available test in risk
of neutrophils, are higher than known normal values. stratification post-STEMI complications. This was based
Increased neutrophil count was associated with higher on the findings of Nunez et al. that showed highest
in-hospital mortality, post-infarction pump failure and neutrophil and lowest lymphocyte counts and maximum
occurrence of serious ventricular arrhythmias within the NLR in 12-24 hours following STEMI had a higher overall
first 24 hours. The presence of neutrophilia after STEMI long-term mortality.17 However, we found that the NLR
(higher than the cutoff value of 9.68×1000 cells/mm3) was inferior to the absolute number of the neutrophils in
was predictive of pump failure and significant increase in predicting in-hospital mortality.
the frequency of ventricular arrhythmias within the first The frequencies of pulmonary edema and VF/VT within
post MI day. Comparably, higher NLR was also associated the first day of admission were associated with higher
with higher frequency of acute pump failure and first day levels of neutrophils and NLR. Association between
arrhythmia following STEMI. higher neutrophil count and heart failure has been
Similar reports by Menonet al., suggested that patients stressed in several studies.20,21 Chia et al. showed that
with higher leukocyte count were at high risk of heart elevated leukocyte and neutrophil counts after primary
failure and cardiogenic shock.9 Barron et al. demonstrated PCI in patients with STEMI were associated with larger
that there was an association between high leukocyte myocardial infarct size and lower LVEF and were

Table 4. Univariate and multivariate analyses of confounding factors in development of post-STEMI pump failure.
With Pump Failure Without Pump Failure Univariate Multivariate
(n=35) (n=369) Analysis P Analysis P
White Blood Cells 12.5 (10.7-13.8) 10.7 (10.3-11.0) 1.10 (1.02-1.20) 0.01 - -

Neutrophils 9.7 (8.3-11.3) 8.3 (7.7-8.7) 1.09 (1.01-1.19) 0.03 1.10 (1.01-1.20) 0.02

Diabetes Mellitus 16 (45.7%) 85 (23.0%) 2.81 (1.39-5.71) 0.004 2.52 (1.21-5.2) 0.003

Female/male 12/23 64/305 2.49 (1.18-5.25) 0.02 2.34 (1.02-4.88) 0.04

Prior myocardial
2 (5.7%) 9 (2.4%) 5.53 (0.98-31.33) 0.05 2.6 (0.50-13.55) 0.25
revascularization
Univariate analysis was done for the following variables: gender, age, family history, prior myocardial revascularization, prior MI,
hypertension, diabetes mellitus, hyperlipidemia, WBC and neutrophil counts and neutrophil-lymphocyte ratio. Five factors were identified
as significant confounding variables for pump failure as defined as development of cardiogenic shock and/or pulmonary edema following
STEMI.
*Since WBC and neutrophil count were collinear variables, we selected only neutrophil count for multivariate analysis.

Table 5. Post-STEMI complications in two groups with high and low neutrophil levels
Neutrophil >9.68 Neutrophil ≤9.68
P
(n=140) (n=264)
VT/VF within 24 hours (Early) 19 (13.6%) 10 (3.8%) <0.001

VT/VF after the first day (Delayed) 4 (2.9%) 4 (1.5%) 0.45

Atrial Fibrillation 6 (4.3%) 14 (5.3%) 0.81

Cardiogenic shock 8 (5.7%) 11 (4.2%) 0.47

Pulmonary edema 12 (8.6%) 9 (3.4%) 0.003

Pericarditis 3 (2.1%) 1 (0.4%) 0.12

J Cardiovasc Thorac Res, 2014, 6(1), 35-41 39

Ghaffari et al.

independent predictors of cardiovascular outcome.22 3. Fuster V, Lewis A. Conner Memorial Lecture.

Similarly, our study patients with evidence of heart failure Mechanisms leading to myocardial infarction:
either as pulmonary edema or cardiogenic shock had insights from studies of vascular biology. Circulation
higher WBC count, neutrophil and NLR ratio. 1994;90:2126-2146.
The association between inflammation and atrial 4. Ross R. Atherosclerosis--an inflammatory disease. N
fibrillation is well studied.23 In our study there was no Engl J Med 1999;340:115-126.
significant difference in total WBC, neutrophils or NLR 5. Thomson SP, Gibbons RJ, Smars PA, Suman VJ,
between those with and without AF. We did not use Pierre RV, Santrach PJ, et al. Incremental value of the
routine holter monitoring in our patients and detailed leukocyte differential and the rapid creatine kinase-
arrhythmia evaluation was not possible after second or MB isoenzyme for the early diagnosis of myocardial
third day when patients were transferred from CCU and infarction. Ann Intern Med 1995;122:335-341.
this may be a confounding factor for this analysis. Data 6. Bhatt DL, Chew DP, Lincoff AM, Simoons ML,
regarding association of ventricular arrhythmias with Harrington RA, Ommen SR, et al. Effect of
CBC results are conflicting.18 Chatterjee et al. reported revascularization on mortality associated with an
that pre-procedural elevated WBC count, neutrophilia elevated white blood cell count in acute coronary
and elevated NLR in patients undergoing PCI were syndromes. Am J Cardiol 2003;92:136-140.
significant predictors of ventricular arrhythmias.24 In 7. Cannon CP, McCabe CH, Wilcox RG, Bentley
our study, higher WBC, neutrophil count and NLR were JH, Braunwald E. Association of white blood cell
found in patients who developed VT/VF within the first count with increased mortality in acute myocardial
day but the difference was not significant for arrhythmias infarction and unstable angina pectoris. OPUS-TIMI
beyond this time course. We postulated this might be 16 Investigators. Am J Cardiol 2001;87:636-639.
secondary to the stress associated with cardioversion and 8. Grzybowski M, Welch RD, Parsons L, Ndumele CE,
possible cardiopulmonary resuscitation in these patients Chen E, Zalenski R, et al. The association between
rather than a primary causative factor. white blood cell count and acute myocardial
In our study NLR did not have a significant relationship infarction in-hospital mortality: findings from the
with mortality but was found to have a direct relationship National Registry of Myocardial Infarction. Acad
with frequency of heart failure and development of Emerg Med 2004;11:1049-1060.
ventricular arrhythmias within the first day. In the studies 9. Menon V, Lessard D, Yarzebski J, Furman MI, Gore
of Nunez et al. NLR level was an independent predictor of JM, Goldberg RJ. Leukocytosis and adverse hospital
in-hospital mortality.17,25 In addition, Horne et al. found outcomes after acute myocardial infarction. Am J
that neutrophil, lymphocyte and NLR were independent Cardiol 2003;92:368-372
factors for predicting death/MI, however among them, 10. Barron HV, Cannon CP, Murphy SA, Braunwald E,
NLR was more powerful predictor of the risk of death/ Gibson CM. Association between white blood cell
MI.16 We believe that lower mortality rate in our study count, epicardial blood flow, myocardial perfusion,
may be responsible for this finding. and clinical outcomes in the setting of acute
In summary, our study showed that this simple and widely myocardial infarction: a thrombolysis in myocardial
available test might help to identify STEMI patients who infarction 10 substudy. Circulation 2000;102:2329-
are at a higher risk of death and developing heart failure 2334
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neutrophil count was found to have the best predictive neutrophilia and congestive heart failure after acute
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2006;5:352-357
Ethical issues 12. Kirtane AJ, Bui A, Murphy SA, Barron HV, Gibson
All patients gave written informed consents and the study CM. Association of peripheral neutrophilia with
was approved by our local Ethics Committee. adverse angiographic outcomes in ST-elevation
myocardial infarction. Am J Cardiol 2004;93:532-
Competing interests 536.
The authors of the present work declare that there is no 13. O’Donoghue M, Morrow DA, Cannon CP, Guo W,
conflict of interest. Murphy SA, Gibson CM, et al. Association between
baseline neutrophil count, clopidogrel therapy,
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