title: Low lymphocyte count in acute phase of ST-segment  elevation myocardial infarction predicts long-term recurrent  myocardial infarction.
abstract: OBJECTIVE
  We sought to determine the relationship between the lowest lymphocyte count (lymphocyte(min))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. Lymphocyte(min) 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). Lymphocyte(min) 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 lymphocyte(min) quartile (Q1r1045 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).
  
  
  CONCLUSIONS
  Low lymphocyte count obtained within the first 96 h of a STEMI predicts the risk of re-MI.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia-España, Spain. yulnunez@gmail.com
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Luis
authors.initials: L
authors.lastname: Mainar
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fácila
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu
authors.forename: Pilar
authors.initials: P
authors.lastname: Merlos
authors.forename: Helene
authors.initials: H
authors.lastname: Darmofal
authors.forename: Patricia
authors.initials: P
authors.lastname: Palau
authors.forename: Angel
authors.initials: A
authors.lastname: Llácer
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000276:immunology* / Q000401:mortality / Q000628:therapy; D010343:Patient Admission; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome