European Journal of Internal Medicine
Volume 20, Issue 8 , Pages 768-774 , December 2009

Therapeutic implications of low lymphocyte count in non-ST segment elevation acute coronary syndromes

  • Julio Núñez

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
    • Corresponding Author InformationCorresponding author. Servicio de Cardiología, Hospital Clínico Universitario, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain. Tel.: +34 96 3347133; fax: +34 963862658.
    • ,
  • Juan Sanchis

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
    • ,
  • Vicent Bodí

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
    • ,
  • Eduardo Núñez

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
    • ,
  • Anne M. Heatta

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
    • ,
  • Gema Miñana

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
    • ,
  • Pilar Merlos

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
    • ,
  • Eva Rumiz

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
    • ,
  • Patricia Palau

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
    • ,
  • Rafael Sanjuán

      Affiliations

    • Unidad Coronaria, Hospital Clínico Universitario, Valencia, Spain
    • ,
  • Maria L. Blasco

      Affiliations

    • Unidad Coronaria, Hospital Clínico Universitario, Valencia, Spain
    • ,
  • Angel Llàcer

      Affiliations

    • Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain

Received 25 July 2009 ,Revised 31 August 2009 ,Accepted 9 September 2009.

References 

  1. Fox KA, Goodman SG, Klein W, Brieger D, Steg PG, Dabbous O, et al. Management of acute coronary syndromes. Variations in practice and outcome; findings from the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2002;23:1177–1189
  2. Dönges K, Schiele R, Gitt A, Wienbergen H, Schneider S, Zahn R, et al. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and Myocardial Infarction Registry (MIR) Study Groups. Incidence, determinants, and clinical course of reinfarction in-hospital after index acute myocardial infarction (results from the pooled data of the maximal individual therapy in acute myocardial infarction [MITRA], and the myocardial infarction registry [MIR]). Am J Cardiol. 2001;87:1039–1044
  3. Kornowski R, Goldbourt U, Zion M, Mandelzweig L, Kaplinsky E, Levo Y, et al. Predictors and long-term prognostic significance of recurrent infarction in the year after a first myocardial infarction. SPRINT Study Group. Am J Cardiol. 1993;72:883–888
  4. Orn S, Cleland JG, Romo M, Kjekshus J, Dickstein K. Recurrent infarction causes the most deaths following myocardial infarction with left ventricular dysfunction. Am J Med. 2005;118:752–758
  5. Qayyum R, Khalid MR, Adomaityte J, Papadakos SP, Messineo FC. Systematic review: comparing routine and selective invasive strategies for the acute coronary syndrome. Ann Int Med. 2008;148:186–196
  6. Mehta SR, Cannon CP, Fox KA, Wallentin L, Boden WE, Spacek R, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005;293:2908–2917
  7. Taleb S, Tedgui A, Mallat Z. Regulatory T-cell immunity and its relevance to atherosclerosis. J Intern Med. 2008;263:489–499
  8. Ducloux D, Challier B, Saas P, Tiberghien P, Chalopin JM. CD4 cell lymphopenia and atherosclerosis in renal transplant recipients. J Am Soc Nephrol. 2003;14:767–772
  9. Major AS, Fazio S, Linton MF. B-lymphocyte deficiency increases atherosclerosis in LDL receptor-null mice. Arterioscler Thromb Vasc Biol. 2002;22:1892–1898
  10. Le Tulzo Y, Pangault C, Gacouin A, Guilloux V, Tribut O, Amiot L, et al. Early circulating lymphocyte apoptosis in human septic shock is associated with poor outcome. Shock. 2002;18:487–494
  11. Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, et al. The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation. 2006;113:1424–1433
  12. Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol. 2000;86:449–451
  13. Ridker PM, Cannon CP, Morrow D, Rifai N, Rose LM, McCabe CH, et al. C-reactive protein levels and outcomes after statin therapy. N Engl J Med. 2005;352:20–28
  14. Lagerqvist B, Diderholm E, Lindahl B, Husted S, Kontny F, Ståhle E, et al. FRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease. Heart. 2005;91:1047–1052
  15. Wiviott SD, Cannon CP, Morrow DA, Murphy SA, Gibson CM, McCabe CH, et al. Differential expression of cardiac biomarkers by gender in patients with unstable angina/non-ST-elevation myocardial infarction: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy—Thrombolysis In Myocardial Infarction 18) substudy. Circulation. 2004;109:580–586
  16. Bhatt DL, Chew DP, Lincoff AM, Simoons ML, Harrington RA, Ommen SR, et al. Effect of revascularization on mortality associated with an elevated white blood cell count in acute coronary syndromes. Am J Cardiol. 2003;92:136–140
  17. Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E, et al. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation; recommendations of the Task Force of the European Society of Cardiology. Eur Heart J. 2000;21:1406–1432
  18. Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E, et al. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2002;23:1809–1840
  19. Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J. 2000;21:1502–1513
  20. Gray R. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–1154
  21. Fine J, Gray RJ. A proportional hazard model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509
  22. Bhatt DL, Roe MT, Peterson ED, Li Y, Chen AY, Harrington RA, et al. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA. 2004;292:2096–2104
  23. Núñez J, Sanchis J, Núñez E, Bodi V, Bertomeu-González V, Bosch MJ, et al. Prognostic differences between routine invasive and conservative strategies for the management of high-risk, non-ST segment acute coronary syndromes: experience from two consecutive periods in a single center. Eur J Intern Med. 2007;18:409–416
  24. Bauer T, Koeth O, Jünger C, Heer T, Wienbergen H, Gitt A, et al. Effect of an invasive strategy on in-hospital outcome in elderly patients with non-ST-elevation myocardial infarction. Eur Heart J. 2007;28:2873–2878
  25. Steg PG, Kerner A, Van de Werf F, López-Sendón J, Gore JM, Fitzgerald G, et al. Impact of in-hospital revascularization on survival in patients with non-ST-elevation acute coronary syndrome and congestive heart failure. Circulation. 2008;118:1163–1171
  26. Keeley EC, Kadakia R, Soman S, Borzak S, McCullough PA. Analysis of long-term survival after revascularization in patients with chronic kidney disease presenting with acute coronary syndromes. Am J Cardiol. 2003;92:509–514
  27. Thomson SP, Gibbons RJ, Smars PA, Suman VJ, Pierre RV, Santrach PJ, et al. Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction. Ann Intern Med. 1995;122:335–341
  28. Blum A, Sclarovsky S, Rehavia E, Shohat B. Levels of T-lymphocyte subpopulations, interleukin-1 beta, and soluble interleukin-2 receptor in acute myocardial infarction. Am Heart J. 1994;127:1226–1230
  29. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol. 1997;79:812–814
  30. Núñez J, Sanchis J, Bodí V, Núñez E, Mainar L, Heatta AM, et al. Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. Atherosclerosis. Jan 29 2009;Electronic publication ahead of print
  31. Stoneman VE, Bennett MR. Role of apoptosis in atherosclerosis and its therapeutic implications. Clin Sci (Lond). 2004;107:343–354
  32. Pasqui AL, Di Renzo M, Bova G, Bruni F, Puccetti L, Pompella G, et al. T cell activation and enhanced apoptosis in non-ST elevation myocardial infarction. Clin Exp Med. 2003;3:37–44
  33. Fox KA, Poole-Wilson PA, Henderson RA, Clayton TC, Chamberlain DA, Shaw TR, et al. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial. Lancet. 2002;360:743–751
  34. Lim MJ, Spencer FA, Gore JM, Dabbous OH, Agnelli G, Kline-Rogers EM, et al. Impact of combined pharmacologic treatment with clopidogrel and a statin on outcomes of patients with non-ST-segment elevation acute coronary syndromes: perspectives from a large multinational registry. Eur Heart J. 2005;26:1063–1069

PII: S0953-6205(09)00183-6

doi: 10.1016/j.ejim.2009.09.006

European Journal of Internal Medicine
Volume 20, Issue 8 , Pages 768-774 , December 2009

Article Tools

* Image Usage & Resolution