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Published on: May 28, 2019
Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary
Mehmet G Kaya1, Mahmut Akpek, Yat Yin Lam
1Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey.
Insights
The pre-procedural neutrophil-to-lymphocyte ratio (N/L) independently predicts adverse cardiac events in ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI. This readily available marker can enhance risk assessment for STEMI outcomes.
Area of Science:
- Cardiology
- Hematology
- Clinical Risk Assessment
Background:
- The prognostic value of the pre-procedural neutrophil-to-lymphocyte (N/L) ratio in ST-segment elevation myocardial infarction (STEMI) requires further investigation.
- Existing research suggests an association between N/L ratio and adverse outcomes in coronary artery disease, but specific data for STEMI patients undergoing primary percutaneous coronary intervention (PCI) is limited.
Purpose of the Study:
- To evaluate the relationship between the pre-procedural N/L ratio and both in-hospital and long-term adverse outcomes in STEMI patients.
- To determine if the N/L ratio can serve as an independent predictor of cardiac events in this patient population.
Main Methods:
- A cohort of 682 STEMI patients presenting within 6 hours of symptom onset were enrolled.
- Patients were stratified into tertiles based on their pre-procedural N/L ratio, determined from blood samples drawn upon emergency room admission.
- Outcomes were assessed during hospitalization and over a mean follow-up period of 43.3 months.
Main Results:
- Higher N/L ratio tertiles were significantly associated with increased rates of in-hospital and long-term in-stent thrombosis, non-fatal myocardial infarction, and cardiovascular mortality.
- The N/L ratio was identified as an independent predictor for both in-hospital and long-term major adverse cardiac events on multivariate analysis.
- Specific independent predictive values were noted: OR 1.189 for in-hospital events (p<0.001) and OR 1.228 for long-term events (p<0.001).
Conclusions:
- The pre-procedural N/L ratio is a significant independent predictor of adverse in-hospital and long-term outcomes in STEMI patients undergoing primary PCI.
- The N/L ratio, being an inexpensive and universally available hematological marker, holds potential for integration into existing risk stratification models for STEMI.
- This finding underscores the utility of simple hematological parameters in predicting cardiovascular events.
Objective:
The pre-procedural neutrophil to lymphocyte ratio (N/L) is associated with adverse outcomes among patients with coronary artery disease but its prognostic value in ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. This study evaluated the relations between pre-procedural N/L ratio and the in-hospital and long-term outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Methods:
A total of 682 STEMI patients presented within the first 6h of symptom onset were enrolled and stratified according to tertiles of N/L ratio based on the blood samples obtained in the emergency room upon admission.
Results:
The mean follow-up period was 43.3 months (1-131 months). In-hospital in-stent thrombosis, non-fatal myocardial infarction, and cardiovascular mortality increased as the N/L tertile ratio increased (p<0.001, p<0.001, p=0.003, respectively). Long-term in-stent thrombosis, non-fatal myocardial infarction and cardiovascular mortality also increased as the N/L ratio increased (p<0.001, p<0.001, p=0.002, respectively). On multivariate analysis, N/L ratio remained an independent predictor for both in-hospital (OR 1.189, 95% CI 1.000-1.339; p<0.001) and long-term major (OR 1.228, 95% CI 1.136-1.328; p<0.001) adverse cardiac events.
Conclusion:
The N/L ratio was an independent predictor of both in-hospital and long-term adverse outcomes among STEMI patients undergoing primary PCI. Our findings suggest that this inexpensive, universally available hematological marker may be incorporated into the current established risk assessment model for STEMI.
