Document Detail


Therapeutic implications of low lymphocyte count in non-ST segment elevation acute coronary syndromes.
MedLine Citation:
PMID:  19892306     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
Julio Núñez; Juan Sanchis; Vicent Bodí; Eduardo Núñez; Anne M Heatta; Gema Miñana; Pilar Merlos; Eva Rumiz; Patricia Palau; Rafael Sanjuán; Maria L Blasco; Angel Llàcer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-10-02
Journal Detail:
Title:  European journal of internal medicine     Volume:  20     ISSN:  1879-0828     ISO Abbreviation:  Eur. J. Intern. Med.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-06     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9003220     Medline TA:  Eur J Intern Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  768-74     Citation Subset:  IM    
Affiliation:
Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain. yulnunez@gmail.com
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