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The Age-Specific Impact of Cellular Immunity on Long-Term Outcome after Acute Coronary Syndrome
Niema Kazem1, Felix Hofer1, Lorenz Koller1
1Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
Insights
Cellular immunity markers, specifically neutrophil and lymphocyte fractions and their ratio, predict mortality after acute coronary syndrome (ACS) in older adults. These easily measured values aid in age-specific risk stratification for secondary prevention.
Area of Science:
- Cardiology
- Immunology
- Geriatrics
Background:
- Personalized risk stratification for adverse events after acute coronary syndrome (ACS) is challenging in aging populations.
- Easily applicable strategies for age-specific risk prediction are needed.
- Cellular immunity is associated with coronary vessel disease, suggesting its potential for risk assessment.
Purpose of the Study:
- To investigate the prognostic value of cellular immunity on long-term outcomes after ACS.
- To analyze these effects from an age-specific perspective.
Main Methods:
- Patients with ACS were enrolled in a clinical registry with immune phenotyping.
- Cox-regression hazard analysis was used to assess the impact of cellular immunity on survival.
- Patients were stratified by age (<65 and ≥65 years).
Main Results:
- In patients ≥65 years, lymphocyte fraction, neutrophil granulocyte fraction, and neutrophil-to-lymphocyte ratio (NLR) were independently associated with mortality.
- Higher NLR and neutrophil fraction predicted increased mortality, while higher lymphocyte fraction predicted decreased mortality.
- No significant effect of these cell lines on outcome was observed in patients <65 years.
Conclusions:
- Cellular immunity markers (neutrophil and lymphocyte fractions, NLR) have a significant age-specific effect on outcomes after ACS.
- These routinely available values can be used for age-dependent risk stratification.
- This aids in identifying high-risk patients for improved secondary prevention strategies.
Background:
Personalized risk stratification after acute coronary syndrome (ACS) remains a challenging field in the aging society. Easily applicable strategies for risk prediction of adverse events from an age-specific perspective are needed. Considering the association of cellular immunity with coronary vessel disease, these cell lines mirror a reasonable value for risk assessment. Therefore, we aimed to elucidate the prognostic value of cellular immunity on long-term outcome after ACS from an age-specific perspective.
Methods:
Patients presenting with ACS at the Vienna General Hospital admitted between December 1996 and January 2010 were enrolled within a clinical registry including standardized assessment of peripheral blood samples and immune phenotyping. Cox-regression hazards analysis was performed to elucidate the impact of cellular immunity on survival.
Results:
A total of 832 patients were included within the final analysis and stratified according to age into individuals <65 years (n = 416) and ≥65 years (n = 416). After a median follow-up time of 8.6 years, a total of 516 (62.0%) individuals died. We found that the fraction of lymphocytes (adjusted hazard ratio [HR] of 0.61 [95% confidence interval, CI: 0.45-0.82]; p = 0.001), the fraction of neutrophil granulocytes (adjusted HR of 5.01 [95% CI: 1.62-15.46]; p = 0.005), and the neutrophil-to-lymphocyte ratio (NLR; adjusted HR of 1.47 [95% CI: 1.16-1.87]; p = 0.002) showed a strong and independent association with mortality in individuals ≥65 years. Notably, there was no effect on outcome observed for any of the tested cell lines in patients <65 years.
Conclusion:
The present investigation highlighted a strong and independent age-specific effect of both the fraction of neutrophil granulocytes and lymphocytes as well as the NLR on outcome. Considering an age-dependent risk stratification, these routinely available values can be easily used to identify patients at risk for fatal events and contribute to proper secondary prevention after ACS.
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