title: The adaptive immune system and long-term outcome in patients with stable coronary disease. Predictive value of routine laboratory measurements.
abstract: Components of the adaptive immune system, in particular lymphocytes and immunoglobulin, play a major role in advanced atherosclerotic lesions. We sought to determine whether routine, measurements of the relative number of circulating lymphocytes (%L) and gamma-globulin (%G) reflecting immunoglobulin are related to event-free survival in patients with stable coronary artery disease (CAD). We prospectively studied the combined endpoint all-cause mortality, myocardial infarction and coronary revascularization procedures in 141 patients after successful percutaneous coronary intervention during a median follow-up time of 13.2 years. Using Cox regression, we found a significant influence of %L on event-free survival (P=0.007) with a relative risk of 2.21 comparing third to first tertile. Subjects with higher %G values likewise had a shorter event-free survival (P=0.008) with a relative risk of 1.67 comparing third to first tertile. The predictive value of %L and %G remained significant after adjustment for demographic data, cardiovascular risk factors, extent of CAD and other inflammatory markers. We conclude that the fraction of gamma-globulin and in particular the relative lymphocyte cell count may serve as readily available and reliable prognostic tools for the long-term outcome in patients with stable CAD.
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. alexander.niessner@meduniwien.ac.at
authors.forename: Alexander
authors.initials: A
authors.lastname: Niessner
authors.forename: Senta
authors.initials: S
authors.lastname: Graf
authors.forename: Mariam
authors.initials: M
authors.lastname: Nikfardjam
authors.forename: Stephan
authors.initials: S
authors.lastname: Lehr
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Johann
authors.initials: J
authors.lastname: Wojta
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
mesh_terms: D001161:Arteriosclerosis; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007107:Immune System; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome; D005719:gamma-Globulins / Q000032:analysis
chemical_list: D015415:Biomarkers; D005719:gamma-Globulins