Neutrophil to lymphocyte ratio in acute ST-segment elevation myocardial infarction

Area of Science:

• Cardiology
• Hematology
• Interventional Cardiology

Background:

• Spontaneous early patency of the infarct-related artery (IRA) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) is linked to improved prognosis.
• Predictive factors for spontaneous IRA patency require further investigation.

Purpose of the Study:

• To determine if demographic parameters on admission are associated with spontaneous IRA patency in STEMI patients.
• To explore the relationship between admission neutrophil-to-lymphocyte ratio (NLR) and IRA patency.

Main Methods:

• Retrospective analysis of 1,625 STEMI patients undergoing primary PCI within 12 hours of symptom onset.
• Correlation of admission hemographic parameters, including neutrophil count, lymphocyte count, and NLR, with angiographic IRA patency (TIMI grade 3 flow).
• Multivariate analysis to identify independent predictors of occluded IRA.

Main Results:

• 160 patients (9.8%) had a patent IRA on admission angiography.
• Lower admission neutrophil counts and higher lymphocyte counts were observed in patients with patent IRA.
• A significantly lower NLR was associated with spontaneous IRA patency (P<0.001).
• Admission NLR was also correlated with the angiographic thrombus burden (TIMI thrombus score).
• Multivariate analysis identified NLR ≥ 4.5 as an independent predictor of an occluded IRA (OR 3.17; P<0.001).

Conclusions:

• Admission NLR is significantly associated with angiographic thrombus burden and spontaneous early IRA patency in acute STEMI patients.
• NLR serves as a valuable, readily available biomarker for predicting IRA status in STEMI.
• These findings may inform treatment strategies and risk stratification in STEMI management.