Relation of Neutrophil to Lymphocyte Ratio With Periprocedural Myocardial Damage in Patients Undergoing Elective Percutaneous Coronary Intervention
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Updated: Mar 16, 2026
An Intact Pericardium Ischemic Rodent Model
Published on: September 2, 2021
Edoardo Bressi1, Fabio Mangiacapra1, Elisabetta Ricottini1
1Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
Insights
Neutrophil to lymphocyte ratio (NLR) does not predict periprocedural myocardial damage after PCI. However, post-PCI, NLR increases significantly, correlating with the extent of myocardial damage, indicating its role as a marker of injury.
Area of Science:
- Cardiology
- Hematology
- Biomarkers
Background:
- Neutrophil to lymphocyte ratio (NLR) is a proposed marker for cardiovascular risk.
- The association between NLR and myocardial damage following percutaneous coronary intervention (PCI) remains unclear.
Purpose of the Study:
- To investigate the relationship between NLR and periprocedural myocardial damage (PMI) after elective PCI.
- To assess whether baseline NLR predicts PMI and if post-PCI NLR changes correlate with myocardial injury markers.
Main Methods:
- A total of 502 patients with stable coronary artery disease undergoing elective PCI were enrolled.
- Blood samples were collected at baseline, 6, and 24 hours post-PCI for complete blood cell counts and cardiac biomarkers (creatine kinase-MB and troponin T).
- NLR was calculated, and PMI was defined per the 2012 universal definition.
Main Results:
- A significant post-PCI increase in NLR was observed in the overall population (p < 0.0001).
- Baseline NLR did not differ between patients with and without PMI (p = 0.898).
- Patients who developed PMI had significantly higher NLR at 6 hours (p < 0.001) and 24 hours (p = 0.003) post-PCI. Post-PCI NLR increase correlated with creatine kinase-MB (rho = 0.377, p = 0.031) and troponin T (rho = 0.506, p = 0.003) levels.
Conclusions:
- Preprocedural NLR does not predict periprocedural myocardial infarction during elective PCI.
- Percutaneous coronary intervention induces a significant increase in NLR.
- The magnitude of this NLR increase appears proportional to the extent of periprocedural myocardial damage.
Abstract:
Neutrophil to lymphocyte ratio (NLR) has been proposed as a marker of cardiovascular risk. The potential relation between NLR and periprocedural myocardial damage after percutaneous coronary intervention (PCI) is unclear. We enrolled 502 consecutive patients with stable coronary artery disease undergoing elective PCI. Blood samples were drawn in all patients at baseline, 6 hours, and 24 hours after PCI for complete blood cell count and cardiac biomarkers (creatine kinase-MB and troponin T [Tn-T]) assessment. NLR was calculated as the ratio between the absolute number of neutrophil over the absolute number of lymphocyte. Periprocedural myocardial infarction (PMI) was defined according to the 2012 universal definition of myocardial infarction. In the overall population, a significant postprocedural increase in NLR was observed (3.255 [2.763 to 3.995] at baseline, 4.430 [3.390 to 6.020] at 6 hours, 4.720 [3.940 to 5.750] at 24 hours, p <0.0001). PMI occurred in 33 patients (6.6%). Baseline NLR was similar in patients with and without PMI (3.250 [2.820 to 3.885] vs 3.260 [2.750 to 4.000], p = 0.898); however, patients who developed PMI showed significantly higher NLR both at 6 hours (5.750 [4.360 to 9.095] vs 4.370 [3.370 to 5.950], p <0.001) and 24 hours (5.180 [4.440 to 8.065] vs 4.670 [3.920 to 5.710], p = 0.003). Among patients who developed PMI, periprocedural NLR increase showed a moderate positive correlation with both creatine kinase-MB (rho = 0.377, p = 0.031) and troponin T increase (rho = 0.506, p = 0.003). In conclusion, preprocedural NLR values do not impact on the occurrence of PMI during elective PCI; however, PCI procedures induce a significant increase in NLR that seems to be proportional to the magnitude of periprocedural myocardial damage.
