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Do Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Reflect Coronary Artery Disease Severity Assessed
Amro Assayed1,2, Saif Aburumman3, Ibrahim Abunemr3
1From the Department of Cardiology, University of Central Florida, Orlando, FL.
Insights
Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are simple biomarkers that correlate with coronary artery disease complexity. These hematologic inflammatory indices may aid in preprocedural risk stratification for patients with coronary artery disease.
Area of Science:
- Cardiology
- Inflammation Biology
- Biomarker Discovery
Background:
- Coronary artery disease (CAD) is a leading cause of death globally, with inflammation being key.
- The SYNTAX score assesses coronary lesion complexity but is invasive and costly.
- Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are proposed as accessible inflammatory biomarkers.
Purpose of the Study:
- To evaluate the association between NLR and PLR with angiographic complexity (SYNTAX score) in CAD patients.
- To determine if simple hematologic indices can reflect coronary lesion complexity.
- To assess the utility of NLR and PLR as potential preprocedural risk stratification tools.
Main Methods:
- Systematic review and meta-analysis of studies correlating NLR/PLR with SYNTAX scores.
- Searched PubMed, MEDLINE, Cochrane, CINAHL up to May 2024.
- Used random-effects models and assessed heterogeneity and publication bias.
Main Results:
- Fifteen studies (17,348 participants) were included.
- NLR showed a significant positive correlation with SYNTAX score (r=0.37).
- PLR also demonstrated a significant positive correlation with SYNTAX score (r=0.38).
- Subgroup analyses revealed stronger correlations in Turkish cohorts and with increasing mean age.
Conclusions:
- NLR and PLR correlate moderately with coronary lesion complexity.
- These hematologic indices offer accessible adjunctive markers for risk stratification in CAD.
- NLR and PLR may help in preprocedural assessment of patients with coronary artery disease.
Abstract:
Coronary artery disease is a major global cause of morbidity and mortality, with systemic inflammation playing a central role in its pathophysiology. The SYNTAX (Synergy Between percutaneous coronary intervention With Taxus and Cardiac Surgery) score is widely used to quantify the anatomical complexity of coronary lesions, but its invasiveness and cost limit routine application. Hematologic inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been proposed as simple, inexpensive biomarkers that may reflect the presence and severity of coronary disease. This meta-analysis evaluated the association between NLR and PLR and angiographic complexity measured by the SYNTAX score. A systematic search of PubMed, MEDLINE, Cochrane, and CINAHL through May 2024 identified studies reporting correlations between NLR and/or PLR and SYNTAX scores in adults with coronary artery disease. Random-effects models using Fisher's z-transformation were applied to pool correlation coefficients. Heterogeneity was assessed using Cochran's Q, I2, and τ2. Subgroup analyses examined the effects of country, study design, and publication year, and meta-regression explored the influence of mean age and sex distribution. Publication bias was evaluated with funnel plots and Egger's regression. Fifteen studies involving 17,348 participants were included. NLR showed a significant positive correlation with SYNTAX score (r = 0.37; 95% CI, 0.28-0.45). PLR demonstrated a similar association (r = 0.38; 95% CI, 0.23-0.51). Heterogeneity was substantial for both indices. Stronger correlations were observed in Turkish cohorts, and increasing mean age was associated with larger effect sizes. No significant publication bias was detected. Both NLR and PLR correlate moderately with coronary lesion complexity and may provide accessible adjunctive markers for preprocedural risk stratification.
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