Characteristics of peripheral blood cells are independently related to major adverse cardiovascular events after carotid endarterectomy

• Published in: Atherosclerosis plus 2023-06, Vol.52, p.32-40
• Main Authors: Overmars, L. Malin, Mekke, Joost M., van Solinge, Wouter W., De Jager, Saskia C.A., Hulsbergen-Veelken, Cornelia A.R., Hoefer, Imo E., de Kleijn, Dominique P.V., de Borst, Gert J., van der Laan, Sander W., Haitjema, Saskia
• Format: Article
• Language: English
• Subjects: Blood cell characteristics; Carotid endarterectomy; Full Length; Hematology; Inflammation; Intraplaque hemorrhage; Machine learning; Major adverse cardiovascular events; Routine care data
• ISSN: 2667-0895; 2667-0909; 2667-0895
• DOI: 10.1016/j.athplu.2023.05.003

Patients who underwent carotid endarterectomy (CEA) still have a residual risk of 13% of developing a major adverse cardiovascular event (MACE) within 3 years. Inflammatory processes leading up to MACE are not fully understood. Therefore, we examined blood cell characteristics (BCCs), possibly reflecting inflammatory processes, in relation to MACE to identify BCCs that may contribute to an increased risk. We analyzed 75 pretreatment BCCs from the Sapphire analyzer, and clinical data from the Athero-Express biobank in relation to MACE after CEA using Random Survival Forests, and a Generalized Additive Survival Model. To understand biological mechanisms, we related the identified variables to intraplaque hemorrhage (IPH). Of 783 patients, 97 (12%) developed MACE within 3 years after CEA. Red blood cell distribution width (RDW) (HR 1.23 [1.02, 1.68], p = 0.022), CV of lymphocyte size (LACV) (HR 0.78 [0.63, 0.99], p = 0.043), neutrophil complexity of the intracellular structure (NIMN) (HR 0.80 [0.64, 0.98], p = 0.033), mean neutrophil size (NAMN) (HR 0.67 [0.55, 0.83], p