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Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous
Brendan K Duffy1, Hitinder S Gurm, Vivek Rajagopal
1Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Insights
An elevated neutrophil to lymphocyte (N/L) ratio before percutaneous coronary intervention (PCI) predicts long-term mortality. This finding highlights the N/L ratio as a crucial biomarker for assessing patient risk after PCI.
Area of Science:
- Cardiology
- Hematology
- Biomarkers
Background:
- The neutrophil to lymphocyte (N/L) ratio is an emerging predictor of adverse cardiovascular outcomes.
- Previous studies suggest its role in mortality after coronary angiography.
Purpose of the Study:
- To investigate if an elevated preprocedural N/L ratio predicts long-term mortality in patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A cohort of 1,046 patients undergoing PCI were stratified into tertiles based on preprocedural N/L ratio.
- Long-term mortality was tracked using the Social Security Death Index over a mean follow-up of 32 months.
- Multivariable analysis adjusted for clinical factors to assess the independent predictive value of the N/L ratio.
Main Results:
- Higher N/L ratio tertiles were associated with significantly increased long-term mortality (p < 0.0001).
- The N/L ratio, but not white blood cell count, independently predicted mortality (HR 1.85, p=0.01) after adjustment.
- This association remained significant even when excluding patients with acute myocardial infarction.
Conclusions:
- An elevated preprocedural N/L ratio is a significant independent predictor of long-term mortality in patients undergoing PCI.
- The N/L ratio serves as a valuable prognostic biomarker in this patient population.
- Further research may explore the mechanisms underlying this association.
Abstract:
The neutrophil to lymphocyte (N/L) ratio is a recently described independent predictor of death/myocardial infarction in patients who have undergone coronary angiography. We hypothesized that an elevated N/L ratio would be a predictor of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). A total of 1,046 patients who underwent PCI were divided into tertiles based on their preprocedural N/L ratio (mean N/L ratio, tertile 1, 1.7 +/- 0.5; tertile 2: 3.2 +/- 0.6; tertile 3, 11.2 +/- 12.9). Vital status was assessed using the Social Security Death Index. There were a total of 144 deaths over a mean follow-up of 32 months. The best survival was seen in tertile 1, with an increase in long-term mortality seen in tertiles 2 and 3 (p <0.0001). In multivariable modeling, after adjusting for age, chronic obstructive pulmonary disease, left ventricular ejection fraction, serum hemoglobin, serum creatinine, and lesion severity, the log N/L, but not the white blood cell count, was an independent significant predictor of long-term mortality (hazard ratio 1.85, 95% confidence interval 1.3, to 3.04, p = 0.01). The risk persisted when patients with an acute myocardial infarction were excluded from the analysis (hazard ratio 2.46, 95% confidence interval 1.4 to 4.4, p = 0.002). In conclusion, an elevated preprocedural N/L ratio in patients undergoing PCI is associated with an increased risk of long-term mortality.