Lymphopenia in Acute Phase of ST-Segment Elevation ...
LYMPHOPENIA IN ACUTE PHASE OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION PREDICTS LONG-TERM REINFARCTION
J. Núñez, V. Bodí, J. Sanchis, L. Mainar, G. Miñana, P.Merlos, P. Palau, E. Rumiz,
E. Núñez, A. Llàcer
Hospital Clínico Universitario, Universitat de Valencia, Valencia,Spian
Objectives: We sought to determine the relationship between low lymphocyte count (lymphocytemin) obtained within the first 96 hours of symptom onset and the risk of spontaneous postdischarge reinfarction in patients admitted whit ST-segment elevation myocardial infarction (STEMI).
Background: Risk of reinfarction following STEMI has not been well defined. Lymphopenia is a common finding during STEMI and has been associated with atherosclerosis progression and adverse outcomes in different cardiovascular diseases.
Methods: We analyzed 549 consecutive patients admitted with STEMI from a single academic hospital. Lymphocyte counts were determined at admission and routinely during the first 96 hours. Lymphocytemin value from all measurements was selected as the main exposure. Patients with inflammatory or infectious diseases, in-hospital death or reinfarction were excluded from the analysis (final sample=426 patients). Lymphocytemin were divided into quartiles (Q) and their association with spontaneous reinfarction was assessed by cumulative incidence function and competing risk regression. All-cause death and undergoing revascularization procedures were considered competing risk events.
Results: During a median follow-up of 36 months, 53 reinfarctions (12.4%) were registered. Reinfarction crude rate was significantly higher in patients in the lowest lymphocytemin quartile (Q1≤1045 cells/ml) compared with Q2-Q4: 22.4%, 9.4%, 8.4%, 9.4%, respectively; p=0.005. In multivariate setting, Q1 was also associated with a significant increased risk of reinfarction compared with Q2-Q4 (HR: 2.34, 95% CI= 1.28 to 4.39; p=0.006).
Conclusions: Low lymphocyte count obtained within the first 96 hours of an STEMI is a marker of spontaneous postdischarge reinfarction.
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