European Journal of Cardiovascular Medicine

Acute myocardial infarction (AMI), commonly known as a heart attack is a leading cause of mortality in developed countries, posing a significant threat to public health. “Over a million sufferers may travel there every year, and the condition affects over three million people worldwide. The two primary kinds of acute myocardial infarction are non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) (STEMI)”. NSTEMI and unstable angina are comparable. However, there are no indications of a heart condition.[1,2]

Due to a lack of oxygen, AMI damages the heart muscle permanently. “A MI can impair both systolic and diastolic heart function, increasing the patient's risk for arrhythmias. A MI can result in a multitude of very serious issues. Once the blood supply has been restored, the heart will begin to beat once more”. If medical care is sought fewer than six hours after the development of the first disease symptom, the prognosis is better.

A reduction in the amount of blood flow to the heart causes acute myocardial infarction. “When the body's oxygen needs are not supplied, heart ischemia occurs. There are many reasons why the heart's blood flow is reduced. Atherosclerotic plaque rupture frequently results in thrombosis, which significantly reduces coronary blood flow. Coronary artery embolism, which affects 2.9% of patients, cocaine-induced ischemia, coronary dissection, and coronary vasospasm are additional reasons of reduced oxygenation and myocardial ischemia”.[3,4]

Atherosclerotic plaque blockages account for 70% of the mortality in patients with acute myocardial infarction. “Risk factors for atherosclerotic disease are frequently addressed in order to prevent disease because atherosclerosis is the primary cause of acute myocardial infarction. Ninety percent of myocardial infarctions in males and ninety-four percent in women are caused by modifiable variables. Smoking, inactivity, high blood pressure, obesity, cholesterol, LDL cholesterol, and triglyceride levels are risk factors that can be altered. Other factors, such as age, gender, and a family history of atherosclerosis, however, cannot be altered..[5,6] The most prevalent kind of heart disease and the main factor in both illness and death for people worldwide is coronary artery disease (CAD)”. People across the Indian subcontinent die from CAD five to ten years sooner than in the West.[7] The study to aim the prognostic significance of white blood cell count and plasma glucose level at admission in acute ST elevation myocardial infarction terms of in hospital mortality.

This study was conducted at the Katihar Medical College and Hospital in Bihar from July 2022 to December 2023.

80 consecutive patients with a recent acute ST-elevation myocardial infarction were gathered by the department of general medicine at the Katihar Medical College and Hospital. These patients underwent routine testing for white blood cells, plasma glucose, and other variables at the time of admission.

Study Design: Cross Sectional Study

Sample Size: 80

Duration of Study: 18 months

Before starting the study, patients were made aware of it and their informed consent was obtained.

Inclusion Criteria

“All acute myocardial infarction patients having:

• Chest pain lasting more than 20 min
• Diagnostic electrocardiogram (ECG) changes with characteristic ECG alterations consisting of new pathological Q waves or ST segment and T wave changes
• Elevated creatine kinase MB levels >2 times the upper limit of normal.

Exclusion Criteria

• All patients who did not fulfil the inclusion criteria.
• Patients receiving drugs/iv fluids elevating blood glucose levels.
• Post-surgical or post traumatic, up to one month.

Statistical Analysis:

For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests, which compare the means of independent or unpaired samples, were used to assess differences between groups. Paired t-tests, which account for the correlation between paired observations, offer greater power than unpaired tests. Chi-square tests (χ² tests) were employed to evaluate hypotheses where the sampling distribution of the test statistic follows a chi-squared distribution under the null hypothesis; Pearson's chi-squared test is often referred to simply as the chi-squared test. For comparisons of unpaired proportions, either the chi-square test or Fisher’s exact test was used, depending on the context. To perform t-tests, the relevant formulae for test statistics, which either exactly follow or closely approximate a t-distribution under the null hypothesis, were applied, with specific degrees of freedom indicated for each test. P-values were determined from Student's t-distribution tables. A p-value ≤ 0.05 was considered statistically significant, leading to the rejection of the null hypothesis in favour of the alternative hypothesis.

Table 1: Distribution of Diabetic Patients, patients in High RBS (>200) and Low RBS (<180) and High WBC (> 11000) and Low WBC (< 11000)

Table 2: Distibuition of Mortality in High RBS and WBC patients and Mortality in Low RBS and Low WBC patients

In our study, 49 (61.3%) patients had Diabetics. The value of z is 2.846. The value of p is .00438. The result is significant at p < .05. In our study, 61 (76.2%) patients had Low RBS and 19 (23.7%) patients had High RBS of Random Blood sugar of  patients in High RBS (>200) and Low RBS (<180).The value of z is 6.6408. The value of p is < .00001. The result is significant at p < .05. Based on the chart 15 patients have high WBC (18.7%) and 65 patients have low WBC (81.2%). The value of z is 7.9057. The value of p is < .00001. The result is significant at p < .05.

In our study, 6 (100%) patients had Death in High RBS & WBC. The value of z is 3.4641. The value of p is .00054. The result is significant at p < .05. In our study, 4 (7.6%) patients had Death and 48 (92.3%) patients had Death in Low RBS and WBC. The value of z is 8.6291. The value of p is < .00001. The result is significant at p < .05.

Our study examined the clinical outcomes of patients presenting with acute ST- Elevation Myocardial Infarction (STEMI) based on their Total Leukocyte Count (TLC) count and Random Blood Sugar (RBS) levels. After conducting a thorough medical history and physical examination, we collected data on Random Blood Sugar (RBS) levels, Total Leukocyte Count (TLC), Electrocardiogram (ECG), and Echocardiogram. The patients were followed up to monitor complications such as congestive cardiac failure and other outcomes, with death being the endpoint of the study. We analyzed all the values, including in-hospitals mortality data and ejection fraction. The patients were grouped based on their WBC and RBS counts, which were classified as high or low, and then further divided into subgroups based on their mortality rates.

In my study total 80 patients of myocardial infarction were included in which 78.8% (63) were males and 21.2% (17) were females. The average age of patients in my study was 58. In the similar study conducted by Salwan et al. [8], a total of 100 patients were enrolled, with a majority being female. The average age of the patients in the study was 60 years

A majority of the patients in our study, 61.3% (49/80), reported a history of smoking with a mortality of 13 patients (26.5%) Meanwhile, among the 31 non- smokers (38.7%) mortality was seen in 8 patients (25.8%). Meanwhile, the non-smoking group, comprising 44.4% (16,664 individuals), had a mortality rate of 8.7% (1,450)

Number of patients who had RBS >200 were 19(23.7%) and mortality was seen in 14(73.6%) whereas patients with RBS< 200 were 61(76.2%) with a mortality of 7(11.4%) in the study conducted by me. In the study of patel et al [9] 16 (32%) patients having high RBS had a mortality of 12(75%) and the Number of patients with low RBS was 38 (76%) and mortality was seen in 7(18%). Salwan et al [8], in their study also observed high death rates in patients who had higher blood glucosee levels at the time of admission being 14(58.3%) as compared to patients with low RBS being 2 (1.9%).

In our study, 15 (18.7%) patients had high TLC, and among them mortality was observed in 9 (60%) whereas number of patients with Low TLC were 65(81.2%) and mortality was seen in 12(18.4%). In salwan et al [8] study the number of patients with high TLC were 59 (59%) and mortality was seen in 15(25.4%) and patients with Low TLC were 41(41%) and mortality among them was seen in 1(2.4%).In barorn et al [10] number of patients with high TLC were 115(11.8%) and mortality in was seen in 12(10%) whereas patients with Low TLC had low mortality rate.

In our study, mortality in patients who had High TLC and RBS was 100% as compared to patients with Low TLC and RBS which was 7.6%. Our results have concordance with the study conducted by Ishihara et al [11], in which patient with High TLC and RBS have a mortality of 11.8% as compared to patients with Low TLC and RBS which was 2.4%

Salwan et al [8] observed the same that is mortality was more in patients with High TLC and RBS being 83% as compared to patients with Low TLC and RBS which was 4%. Similar resultswere shown in the study by Pathria et al [12], in which they observed higher mortality in patients who had both higher TLC and RBS compared to patient’s whith Low TLC and RBS.

In conclusion, elevated plasma glucose and white blood cell (WBC) counts at the time of admission in patients with acute myocardial infarction (AMI) are significant prognostic indicators. Both hyperglycemia and leukocytosis are associated with increased in-hospital complications, higher mortality rates, and poorer long-term outcomes. These findings highlight the importance of early detection and management of these markers in AMI patients, as they can provide valuable insight into the severity of the condition and guide treatment strategies to improve patient outcomes.

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