Núñez Julio, Sanchis Juan, Bodí Vicent, Núñez Eduardo, Mainar Luis, Heatta Anne M, Husser Oliver, Miñana Gema, Merlos Pilar, Darmofal Helene, Pellicer Mauricio, Llàcer Angel
Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Avda. Blasco Ibáñez 17, Valencia, Spain.
Atherosclerosis. 2009 Sep;206(1):251-7. doi: 10.1016/j.atherosclerosis.2009.01.029. Epub 2009 Jan 29.
Risk stratification of patients with acute chest pain, non-diagnostic electrocardiogram and normal troponin (ACPneg) remains a challenge, partly because no standardized set of biomarkers with prognostic ability has been identified in this population. Lymphopenia has been associated with atherosclerosis progression and adverse outcomes in cardiovascular diseases; although its prognostic value in ACPneg is unknown. We sought to determine the relationship between the lymphocyte count obtained in the Emergency Department (ED) and the risk of the long-term all-cause mortality or myocardial infarction (MI) in patients with ACPneg.
We analyzed 1030 consecutive patients admitted with ACPneg in our institution. Lymphocyte count was determined in the ED as a part of a routine diagnostic workup to rule out an acute coronary syndrome. Patients with inflammatory, infectious diseases, or active malignancy were excluded (final sample=975). The independent association between lymphocyte count and the composite endpoint (death/MI) was assessed by survival analysis for competing risk events (revascularization procedures).
During a median follow-up of 36 months, 139 (14.3%) patients achieved the combined endpoint, with rates increasing monotonically across lymphocyte quartiles (6.2%, 10%, 20.6% and 24.1% for Q4, Q3, Q2 and Q1 (p<0.001), respectively). In a multivariable analysis, patients in lymphocytes' Q1 and Q2 as compared with those in Q4 had an increased risk for the combined endpoint: HR=2.45 (CI 95% 1.25-4.79, p=0.008) and HR=2.56 (CI 95% 1.30-5.07, p=0.007), respectively.
In patients with ACPneg, low lymphocytes count was associated with an increased risk for developing the combined endpoint of death or MI.
对急性胸痛、心电图无诊断意义且肌钙蛋白正常（ACPneg）的患者进行风险分层仍然是一项挑战，部分原因是在该人群中尚未确定一套具有预后能力的标准化生物标志物。淋巴细胞减少与动脉粥样硬化进展及心血管疾病的不良结局相关；尽管其在ACPneg中的预后价值尚不清楚。我们试图确定急诊科（ED）获得的淋巴细胞计数与ACPneg患者长期全因死亡率或心肌梗死（MI）风险之间的关系。
我们分析了我院连续收治的1030例ACPneg患者。作为排除急性冠状动脉综合征的常规诊断检查的一部分，在急诊科测定淋巴细胞计数。排除患有炎症性、感染性疾病或活动性恶性肿瘤的患者（最终样本 = 975例）。通过竞争风险事件（血运重建手术）的生存分析评估淋巴细胞计数与复合终点（死亡/MI）之间的独立关联。
在中位随访36个月期间，139例（14.3%）患者达到联合终点，各淋巴细胞四分位数组的发生率呈单调增加（Q4、Q3、Q2和Q1分别为6.2%、10%、20.6%和24.1%，p<0.001）。在多变量分析中，与Q4组相比，淋巴细胞Q1和Q2组患者发生联合终点的风险增加：HR分别为2.45（95%CI 1.25 - 4.79，p = 0.008）和HR = 2.56（95%CI 1.30 - 5.07，p = 0.007）。
在ACPneg患者中，低淋巴细胞计数与发生死亡或MI联合终点的风险增加相关。
