1. Therapeutic implications of low lymphocyte count in non-ST segment elevation acute coronary syndromes.
- Author
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Núñez J, Sanchis J, Bodí V, Núñez E, Heatta AM, Miñana G, Merlos P, Rumiz E, Palau P, Sanjuán R, Blasco ML, and Llàcer A
- Subjects
- Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome mortality, Acute Coronary Syndrome surgery, Acute Coronary Syndrome therapy, Aged, Electrocardiography, Female, Humans, Lymphopenia complications, Male, Myocardial Infarction etiology, Myocardial Infarction immunology, Myocardial Revascularization mortality, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Factors, Treatment Outcome, Acute Coronary Syndrome immunology, Lymphocyte Count, Myocardial Revascularization adverse effects
- Abstract
Background: Low lymphocyte count (LLC), a surrogate for inflammation, has emerged as a potential risk factor for cardiovascular outcomes, especially new ischemic events. To identify patients with non-ST segment elevation acute coronary syndromes (NSTEACS) who benefit from an invasive revascularization strategy remains a challenge. We sought to determine if patients with high-risk NSTEACS who exhibited LLC have a greater reduction in long-term post-discharge myocardial infarction (MI) when managed under a revascularization invasive strategy (RIS) as compared with conservative strategy (CS)., Methods: Nine hundred seventy two consecutive patients with high-risk NSTEACS were treated under two revascularization strategies (RS): 1) CS, from January 2001 to October 2002 (345 patients; 35.5%) and 2) RIS, from November 2002 to May 2005 (627 patients; 64.5%). LLC was defined as lymphocytes count < or =1200 cells/ml (1 vs. 2-4 quartiles). The association between the type of RS and MI was stratified by lymphocyte count status and assessed by Cox regression adapted for competing events., Results: At 3-year follow-up, 145 deaths (14.9%), 135 MI (13.9%) and 76 revascularization procedures (7.8%) were registered. In a multivariable setting, LLC patients exhibited a greater MI risk reduction when managed under RIS (HR: 0.40; 95% CI=0.22-0.72, p=0.003). Conversely, when LLC was not present, no difference in the rate of MI was detected between the two RS., Conclusions: LLC identifies a subgroup of patients with greater reduction in the risk of postdischarge MI when a RIS is applied.
- Published
- 2009
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