Key result
Elevated baseline neutrophils were significantly associated with increased in-hospital mortality (OR 2.06, p<0.001), with a comparable count conferring disproportionate risk in ethnic minorities.
Why the study?
Elevated neutrophils are linked to poor prognosis after AMI, but whether ethnicity influences the association between neutrophil count and outcome is unknown.
Does elevated neutrophil count predict in-hospital and 60-day mortality differently across ethnic groups in patients with acute myocardial infarction?
Cohort (n=3,062)
Does elevated neutrophil count predict in-hospital and 60-day mortality differently across ethnic groups in patients with acute myocardial infarction?
Elevated neutrophil count post-AMI is an independent predictor of mortality, conferring a disproportionately higher risk in ethnic minority patients compared to white patients.
Ethnicity may modify neutrophil prognostic value post-AMI; leaves open whether ethnicity-adjusted thresholds improve risk stratification.
Aims Elevated neutrophils are associated with a poor prognosis after acute myocardial infarction (AMI) but it is not known if ethnicity influences the association between neutrophil count and outcome. We aimed to describe the temporal dynamics of neutrophils after AMI, and assess the interaction between ethnicity, neutrophil count, and outcomes after AMI. Methods Consecutive patients presenting with AMI between 2016 and 2023 were divided into two groups according to their median neutrophil count. Ethnicity was dichotomised as white and other ethnic groups combined (referred to as ‘ethnic minorities'). The primary outcome was in-hospital mortality, with a secondary outcome of 60-day mortality. Results In our study of 3062 AMI patients (76 % white, 24 % from ethnic minority groups), we found that neutrophil counts rose early post AMI, which coincided with a nadir of the other cell groups. We identified a relative baseline neutropenia in ethnic minority individuals, compared to white individuals (6.85 vs 8.42 × 10 9 /L). We observed a significant, independent association between elevated neutrophils at baseline and the primary outcome of in-hospital mortality (OR 2.06, p < 0.001) and secondary outcome of 60-day all-cause mortality (HR 1.08, p = 0.002). Sub-group analysis revealed a significant interaction between ethnicity and elevated neutrophils (p = 0.004), indicating that a comparable neutrophil count conferred an increased risk for ethnic minority patients for both outcomes. Conclusions We report ethnicity-specific leucocyte dynamics after AMI. Furthermore, neutrophil count is associated with a disproportionate risk in ethnic minority compared with white individuals. Understanding post-AMI inflammation and its interaction with ethnicity is essential in providing personalised prognostication and patient management.
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Sadler et al. (2025) conducted a cohort in Acute myocardial infarction (AMI) (n=3,062). Elevated neutrophils at baseline (above median) vs. Lower neutrophil count (below median) was evaluated on In-hospital mortality (OR 2.06, p=<0.001). Elevated baseline neutrophils were significantly associated with increased in-hospital mortality (OR 2.06, p<0.001), with a comparable count conferring disproportionate risk in ethnic minorities.
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