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Published on: January 28, 2020
The relationship between the neutrophil-lymphocyte ratio and the coronary collateral circulation in patients with
Me Kalkan1, M Sahin1, Ak Kalkan2
1Department of Cardiology, Kartal Kosuyolu High Specialty Education and Research Hospital, Istanbul, Turkey.
Insights
The neutrophil-lymphocyte ratio (NLR) is higher in patients with poor coronary collateral circulation (CCC) in chronic total occlusion (CTO). This simple inflammatory marker can help predict CCC development in these patients.
Area of Science:
- Cardiology
- Inflammation Markers
- Vascular Biology
Background:
- Previous studies link higher neutrophil and lower lymphocyte counts to adverse cardiovascular outcomes.
- Coronary collateral circulation (CCC) plays a crucial role in mitigating ischemia in coronary chronic total occlusion (CTO).
Purpose of the Study:
- To investigate the association between the neutrophil-lymphocyte ratio (NLR) and the development of CCC in patients with CTO.
- To determine if NLR can serve as a predictor of poor CCC development.
Main Methods:
- A study included 274 patients diagnosed with CTO.
- Patients were categorized into groups with poor (Rentrop grades 0-1) or good (Rentrop grades 2-3) CCC.
- Clinical data and blood analyses were retrospectively collected.
Main Results:
- Patients with poorly developed CCC exhibited significantly higher NLR values compared to those with good CCC (2.6 ± 0.5 vs 2.2 ± 0.4, p<0.001).
- Univariate analysis identified NLR, hs-CRP, WBC, age, diabetes, fasting glucose, and BMI as associated with poor CCC.
- Multivariate analysis revealed NLR (OR 1.88, 95% CI 1.37-2.74; p<0.001), hs-CRP, and WBC as independent predictors of poor CCC.
- Optimal NLR cut-off for predicting poor CCC was 2.17 (77% sensitivity, 65% specificity).
Conclusions:
- NLR is a significant, simple, and inexpensive marker for estimating CCC development in CTO patients.
- NLR can be utilized by cardiologists as a screening tool for inflammation.
- This finding highlights NLR's potential as a novel cardiovascular risk marker.
Objectives:
Previous studies showed the association between the major adverse cardiovascular outcomes and both higher neutrophil and lower lymphocyte counts. We aimed to investigate whether there is an association between the neutrophil-lymphocyte ratio (NLR) value and the development of coronary collateral circulation (CCC) in patients with coronary chronic total occlusion (CTO).
Methods:
A total of 274 patients with CTO were included in this study. Patients were then classified according to their Rentrop collateral grades as either poor (Rentrop grades 0-1) or good (Rentrop grades 2-3). Clinical information and analyses of blood samples were obtained from a review of the patients' charts.
Results:
Although there was no difference between the two groups with regard to cardiovascular risk profiles, the NLR values were significantly higher in the patients who had poorly developed CCC (2.6 ± 0.5 vs 2.2 ± 0.4, p<0.001). NLR, high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), age, diabetes, fasting glucose levels and body mass index were found to have univariate association with poorly developed CCC (p<0.1). In a multivariate logistic regression model, NLR (odds ratio 1.88, 95% confidence interval (CI) 1.37-2.74; p<0.001), high-sensitivity C-reactive protein and WBC were found to be the independent predictors of poor CCC. In receiver operator characteristic curve analysis, the optimal cut-off value of NLR to predict poor CCC was found as 2.17, with 77% sensitivity and 65% specificity.
Conclusion:
NLR, as a novel cardiovascular risk marker, is an important, simple and inexpensive method which can be used by the cardiologist as a screening inflammation tool to estimate the development of CCC in patients with CTO.
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