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

• Published in: Atherosclerosis plus Vol. 52; pp. 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: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2023; Elsevier
• Subjects: Blood cell characteristics; Carotid endarterectomy; Full Length; Hematology; Inflammation; Intraplaque hemorrhage; Machine learning; Major adverse cardiovascular events; Routine care data; IPH; Carotid endarterectomy; Hematology; RSF; RDW; Inflammation; Blood cell characteristics; Intraplaque hemorrhage; NAMN; Major adverse cardiovascular events; MACE; Machine learning; UPOD; Routine care data; CEA
• 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 < 0.001), mean corpuscular volume (MCV) (HR 1.35 [1.09, 1.66], p = 0.005), eGFR (HR 0.65 [0.52, 0.80], p < 0.001); and HDL-cholesterol (HR 0.62 [0.45, 0.85], p = 0.003) were related to MACE. NAMN was related to IPH (OR 0.83 [0.71–0.98], p = 0.02). This is the first study to present a higher RDW and MCV and lower LACV, NIMN and NAMN as biomarkers reflecting inflammatory processes that may contribute to an increased risk of MACE after CEA. •Patients who underwent carotid endarterectomy (CEA) have a 13% residual risk of major adverse cardiovascular events (MACE) after CEA.•Inflammatory processes leading up to MACE after CEA are not fully understood.•Blood cell characteristics were examined in relation to MACE to identify those associated with increased risk.•Red blood cell distribution width, mean neutrophil size (NAMN), and mean corpuscular volume were related to MACE after CEA.•NAMN was also related to intraplaque hemorrhage, indicating its potential role as a marker of plaque instability.