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Low lymphocyte count in acute phase of ST-segment elevation myocardial infarction predicts long-term recurrent myocardial infarction

Núñez, Julioa; Núñez, Eduardoa; Bodí, Vicenta; Sanchis, Juana; Mainar, Luisb; Miñana, Gemaa; Fácila, Lorenzoc; Bertomeu, Vicented; Merlos, Pilara; Darmofal, Helenea; Palau, Patriciaa; Llácer, Angela

doi: 10.1097/MCA.0b013e328332ee15
Pathophysiology and Natural History

Objective: We sought to determine the relationship between the lowest lymphocyte count (lymphocytemin) obtained within the first 96 h of symptoms onset and the risk of postdischarge recurrent spontaneous myocardial infarction (re-MI) in patients admitted with ST-segment elevation MI (STEMI).

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 h. Lymphocytemin 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 was divided into quartiles (Q) and their association with re-MI was assessed by competing risk analysis. Postdischarge death and coronary revascularization were considered competing events.

Results: During a median follow-up of 36 months, 53 re-MI (12.4%) were registered. The re-MI 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 a multivariate setting, Q1 was also associated with a significant increased risk of re-MI compared with Q2–Q4 (hazard ratio: 2.04, 95% confidence interval: 1.11–3.76; P=0.021).

Conclusion: Low lymphocyte count obtained within the first 96 h of a STEMI predicts the risk of re-MI.

aServicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia-España

bHospital de Requena, Valencia-España

cServicio de Cardiología, Hospital Provincial de Castellón, Castellón-España

dServicio de Cardiología, Hospital Universitario de San Juan, Alicante-España, Spain

Correspondence to Julio Núñez, MD, Servicio de Cardiología, Hospital Clínico Universitario, Avda, Blasco Ibáñez 17, 46010 Valencia-España, Spain

Tel: +1 34 65 285 6689; fax: +1 34 96 386 2658;

e-mail: yulnunez@gmail.com

Received 18 June 2009 Revised 11 August 2009 Accepted 1 September 2009

© 2010 Lippincott Williams & Wilkins, Inc.