Background and Aims:
It is assumed that activation of the immune system in coronary artery disease (CAD) leads to atherosclerotic plaque destabilization and to development of acute coronary syndrome (ACS). Thus, previous studies showed elevated levels of different T-lymphocyte subsets in the blood of patients with ACS. Moreover, in a univariant analysis, it was shown that cardiovascular (CV) event-free survival decreased in patients with higher percentages of late-differentiated CD4+ T cells. The aim of this work was to analyze the effect of different T-cell populations on prognosis in patients with CAD independently from the traditional CV risk factors. 

Methods:
We analyzed T-lymphocyte populations in the blood of 70 patients with CAD (50 patients with ACS and 20 patients with stable CAD, mean age 63,7±11,3 years) during the first 24h after admission using multiparametric flow cytometry. We conducted a 3-year follow-up for CV events and performed a logistic regression analysis of risk factors for survival including the traditional CV risk factors and the percentages of T-cell subpopulations.


Results:
We found in the univariate analysis of all T-cell subpopulations that the risk of recurrent CV events during 3 years decreased with the increase in percentages of CD4+ and CD8+ naive T cells (OR [95%CI] respectively, 0.93 [0.87-1.00], p=0.041; 0.92 [0.85-0.98], p=0.015). At the same time 3-year CV risk increased 1.09 times with 1% rise in CD4+ intermediate-differentiated effector memory T cells (Tem ID) (95%CI=1.01-1.18, p=0.032). However, in the multivariate analysis the other independent significant risk factors of CV events were patients’ age and CV events prior to the admission (OR [95%CI] respectively, 1.10 [1.02-1.17], p=0.011; 4.64 [1.11-19.44], p=0.036). Moreover, percentages of CD4+ and CD8+ naive T cells (but not of CD4+ Tem cells) were lower in patients with prior CV events and negatively correlated with patients’ age. Therefore, when analyzed in the multiple regression model, only patient’s age, prior CV events and percentages of CD4+ effector memory T cells were independent risk factors worsening 3-year CV prognosis in CAD patients.

Conclusions:
We showed that the risk of recurrent cardiovascular events during 3 years after the admission of CAD patients increased with the lower percentage of CD4+ and CD8+ naïve T cells and the higher percentage of CD4+ effector memory T cells. However, the amount of subpopulations of naive T cells correlates negatively with patients’ age. Therefore, only the differentiation of effector memory T cells in blood was found to be an independent risk factor for cardiovascular prognosis.

04 - IMPACT OF T-LYMPHOCYTE POPULATIONS ON LONG-TERM CARDIOVASCULAR PROGNOSIS IN PATIENTS WITH CORONARY ARTERY