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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Association of neutrophil-to-lymphocyte ratio with clinical outcomes after percutaneous coronary intervention
Angelo Oliva1,2, Birgit Vogel1, Samantha Sartori1
1Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
Insights
High neutrophil-to-lymphocyte ratio (NLR) indicates increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). This biomarker is particularly useful for patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD).
Area of Science:
- Cardiology
- Inflammation Research
- Biomarker Discovery
Background:
- Inflammation is a key driver of coronary artery disease (CAD).
- Neutrophil-to-lymphocyte ratio (NLR) is a readily available biomarker reflecting immune and inflammatory activity.
- NLR may improve risk stratification for patients with CAD undergoing percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the clinical impact of baseline NLR on outcomes in patients undergoing PCI.
- To assess NLR's role in risk stratification for both chronic coronary syndrome (CCS) and acute coronary syndrome (ACS) patients.
Main Methods:
- Retrospective analysis of 7,287 patients undergoing PCI between 2012-2022.
- Patients stratified into NLR quartiles; outcomes analyzed using Cox regression.
- Primary endpoint: 1-year incidence of major adverse cardiovascular events (MACE), including death, myocardial infarction (MI), and stroke.
Main Results:
- MACE incidence increased across NLR quartiles (5.1% to 9.3%, P=0.004).
- The highest NLR quartile (NLR >5.0) was associated with increased adjusted risks of MACE (adjHR 1.52), death (adjHR 1.71), MI (adjHR 1.53), and bleeding (adjHR 2.01).
- High NLR's ischemic risk was more pronounced in patients with ACS and chronic kidney disease (CKD).
Conclusions:
- Baseline NLR is significantly associated with adverse cardiovascular outcomes in CAD patients post-PCI.
- NLR assessment can enhance risk stratification, especially for ACS and CKD patients.
- NLR serves as a valuable prognostic marker in interventional cardiology.
Aims:
Inflammation contributes significantly to coronary artery disease (CAD). The neutrophil-to-lymphocyte ratio (NLR) has emerged as a readily available biomarker reflecting both inflammatory and immune cells' activity, potentially enhancing risk stratification of patients with CAD. This study evaluates the clinical impact of baseline NLR in patients undergoing percutaneous coronary intervention (PCI) for both chronic coronary syndrome and acute coronary syndrome (ACS).
Methods And Results:
We conducted a retrospective analysis of patients undergoing PCI at Mount Sinai Hospital between 2012 and 2022. Patients were stratified into NLR quartiles and outcomes were analysed using Cox regression models. The primary endpoint was major adverse cardiovascular events (MACEs) at 1-year follow-up, including all-cause death, myocardial infarction (MI), and stroke. A total of 7287 patients were included in the study. Age, male sex, comorbidities, high-sensitivity C-reactive protein, and complexity of PCI tended to be higher in the highest NLR quartiles. At 1 year, MACE incidence increased across NLR quartiles, from 5.1% (1st quartile) to 9.3% (4th quartile) (P for trend = 0.004). Compared with the 1st quartile, the 4th NLR quartile (NLR > 5.0) was associated with increased adjusted risks of MACE [adjusted hazard ratio (adjHR) 1.52, 95% CI 1.12-2.05], all-cause death (adjHR 1.71, 95% CI 1.10-2.65), MI (adjHR 1.53, 95% CI 1.00-2.35), and bleeding (adjHR 2.01, 95% CI 1.50-2.70). Ischaemic risk associated with high NLR was more pronounced in patients presenting with ACS and chronic kidney disease (CKD).
Conclusion:
Baseline NLR is associated with adverse cardiovascular outcomes in CAD patients undergoing PCI. Assessment of NLR could enhance risk stratification particularly in patients with ACS and CKD.
