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Published on: January 28, 2020
Predictive Value of Lymphocyte Based Indices to Determine Major Adverse Cardiovascular Events in Acute Coronary
Vivek Mohanty1, Surender Deora1, Atul Kaushik1
1Medical College, All India Institute of Medical Sciences, Jodhpur, Room No. 3131, Jodhpur, Rajasthan 342005 India.
Insights
Post-percutaneous coronary intervention (PCI) inflammatory markers, particularly the systemic inflammatory index (SII), effectively predict major adverse cardiac events (MACE) in acute coronary syndrome (ACS) patients, indicating improved prognosis with reduced inflammation.
Area of Science:
- Cardiology
- Hematology
- Inflammation Research
Background:
- Acute coronary syndrome (ACS) is a primary global cause of mortality.
- Percutaneous coronary intervention (PCI) is a standard ACS treatment, but can induce inflammation.
- Lymphocyte-based hematological indices (NLR, PLR, MLR, SII) indicate inflammatory status.
Purpose of the Study:
- To assess changes in NLR, PLR, MLR, and SII before and after PCI in ACS patients.
- To evaluate the predictive value of these indices for major adverse cardiac events (MACE) and prognosis.
- To compare the predictive power of pre-PCI versus post-PCI inflammatory markers.
Main Methods:
- Prospective observational follow-up study of 403 ACS patients.
- Blood samples collected at admission and within 48 hours post-PCI.
- Analysis included ROC curves and Cox multivariate analysis for MACE prediction.
Main Results:
- NLR, PLR, MLR, and SII decreased post-PCI, suggesting inflammation resolution.
- Post-PCI SII demonstrated the highest predictive value for MACE incidence.
- Elevated post-PCI inflammatory indices correlated with poorer survival outcomes and MACE.
Conclusions:
- Post-PCI inflammatory markers, especially SII, are stronger predictors of MACE than pre-PCI markers in ACS patients.
- Hematological inflammatory indices post-PCI are significant predictors of MACE and all-cause mortality.
- Reduced inflammatory markers post-PCI are associated with better survival outcomes.
Abstract:
Acute coronary syndrome (ACS) is leading cause of mortality worldwide. Percutaneous coronary intervention (PCI) is the main stay of treatment in patients presenting with ACS. However, studies have shown that PCI itself may induce and promote inflammatory process. Lymphocyte based hematological indices: neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), monocyte lymphocyte ratio (MLR) and systemic inflammatory index (SII) have been shown as effective indicator of underlying inflammatory process. We conducted a prospective observational follow up study to observe the changes in NLR, PLR, MLR and SII before and after PCI in ACS patients and their predictive value in determining major adverse cardiac events (MACE) and prognosis in these patients. Blood samples were collected from 403 ACS patients at admission and within 48 h of PCI. NLR, PLR, MLR and SII decreased from baseline which was suggestive of resolving inflammation following PCI. ROC curve analysis showed post PCI SII has highest predictive value for incidence of MACE. Cox multivariate analysis showed post-PCI hematological indices were predictors of MACE including all-cause mortality. Patients with elevated inflammatory indices had poor survival outcomes compared to those having low values. Thus, it could be concluded that compared to pre-PCI inflammatory markers, post-PCI inflammatory markers showed stronger correlation in predicting MACE. Among post PCI indices, SII had the strongest correlation with incidence of MACE during the follow up.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s12291-024-01188-x.
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