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Derived neutrophil-to-lymphocyte ratio as a predictor of no-reflow in ST-elevation myocardial infarction
Alperen Taş1, Muhammet Salih Ateş1, Çağatay Tunca2
1Department of Cardiology, Ahi Evran University Faculty of Medicine, Kırşehir, Turkey.
Insights
The derived neutrophil-to-lymphocyte ratio (dNLR) can predict no-reflow (NR) in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). Higher dNLR indicates increased risk for this serious complication.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- No-reflow (NR) is a major complication of primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI), associated with poor prognosis.
- Inflammation plays a critical role in the development of NR.
- Identifying reliable predictors of NR is crucial for risk stratification and management.
Purpose of the Study:
- To investigate the association between the derived neutrophil-to-lymphocyte ratio (dNLR) and the occurrence of NR in STEMI patients undergoing primary PCI.
- To evaluate the predictive value of dNLR for NR post-PCI.
Main Methods:
- Retrospective, single-center observational study of 208 STEMI patients undergoing primary PCI.
- Patients categorized based on post-procedural TIMI flow grade.
- Comparison of demographic, clinical, and laboratory parameters; regression and ROC analyses performed.
Main Results:
- No-reflow occurred in 26.4% of patients.
- The NR group exhibited significantly higher dNLR, C-reactive protein (CRP), glucose, creatinine, and troponin levels, and lower left ventricular ejection fraction (LVEF).
- dNLR, diabetes mellitus, CRP, and LVEF were identified as independent predictors of NR.
Conclusions:
- The derived neutrophil-to-lymphocyte ratio (dNLR) is a simple, cost-effective biomarker for identifying STEMI patients at high risk of no-reflow.
- Further prospective research is recommended to validate these findings.
Aims:
The no-reflow (NR) phenomenon is a serious complication of primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI), often reflecting distal embolization and microvascular obstruction, and representing a substrate for periprocedural (type 4a) myocardial infarction. NR has been linked to worse prognosis, including higher short- and long-term mortality. Inflammation is a key contributor to NR development. This study aimed to evaluate the relationship between the derived neutrophil-to-lymphocyte ratio (dNLR) and NR in STEMI patients undergoing PCI, and to assess its predictive value.
Methods:
This retrospective, single-center observational study included consecutive STEMI patients undergoing primary PCI between May 2024 and May 2025. Patients were grouped based on post-procedural TIMI flow grade. Demographic, clinical, and laboratory parameters were compared. Regression and ROC analyses were performed.
Results:
A total of 208 patients were analyzed, among whom no-reflow occurred in 26.4% (n = 55). The NR group had significantly higher dNLR, C-reactive protein (CRP), glucose, creatinine, and troponin levels, along with lower left ventricular ejection fraction (LVEF). dNLR, diabetes mellitus, CRP and LVEF were independent predictors of NR.
Conclusion:
dNLR is a simple, cost-effective marker that may help identify patients at high risk of no-reflow in STEMI. Further prospective studies are warranted.
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