Coronary artery disease
Prognostic Value of Neutrophil to Lymphocyte Ratio in Patients Presenting With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2012.11.012Get rights and content

Atherosclerosis is an inflammatory process, and inflammatory biomarkers have been identified as useful predictors of clinical outcomes. The prognostic value of leukocyte count in patients with ST-segment elevation myocardial infarctions who undergo primary percutaneous coronary intervention is not clearly defined. In 325 patients with STEMIs treated with primary percutaneous coronary intervention, total and differential leukocyte counts, once at admission and 24 hours thereafter, were measured. The neutrophil/lymphocyte ratio (NLR) was calculated as the ratio of neutrophil count to lymphocyte count. The primary end point was all-cause death. Twenty-five patients (7.7%) died during follow-up (median 1,092 days, interquartile range 632 to 1,464). The total leukocyte count decreased (from 11,853 ± 3,946/μl to 11,245 ± 3,979/μl, p = 0.004) from baseline to 24 hours after admission. Patients who died had higher neutrophil counts (9,887 ± 5,417/μl vs 8,399 ± 3,639/μl, p = 0.061), lower lymphocyte counts (1,566 ± 786/μl vs 1,899 ± 770/μl, p = 0.039), and higher NLRs (8.58 ± 7.41 vs 5.51 ± 4.20, p = 0.001) at 24 hours after admission. Baseline leukocyte profile was not associated with outcomes. The best cut-off value of 24-hour NLR to predict mortality was 5.44 (area under the curve 0.72, 95% confidence interval [CI] 0.52 to 0.82). In multivariate analysis, a 24-hour NLR ≥5.44 was an independent predictor of mortality (hazard ratio 3.12, 95% CI 1.14 to 8.55), along with chronic kidney disease (hazard ratio 4.23, 95% CI 1.62 to 11.1) and the left ventricular ejection fraction (hazard ratio 0.94 for a 3% increase, 95% CI 0.76 to 0.93). In conclusion, NLR at 24 hours after admission can be used for risk stratification in patients with STEMIs who undergo primary PCI. Patients with STEMIs with 24-hour NLRs ≥5.44 are at increased risk for mortality and should receive more intensive treatment.

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Methods

From July 2003 through February 2010, a total of 325 patients with STEMIs treated with primary PCI and with leukocyte profiles at admission and 24 hours thereafter were analyzed. We excluded patients with symptom onset >12 hours, underlying cancer, chronic inflammatory disease, or any systemic infection that occurred during the first 24 hours after admission. Patients referred to bypass surgery <24 hours after admission were excluded as well. Primary PCI was performed using conventional

Results

A total of 325 patients were available for the final analysis. The clinical and angiographic characteristics of the study population are listed in Table 1. Overall, the mean age was 60.9 years, and most patients were men (71%). Fifty percent of patients had hypertension, 27.4% had diabetes mellitus, and 35.7% had chronic kidney disease.

We examined whether there was a change in total and differential leukocyte counts between the initial measurement and those at 24 hours after admission. During

Discussion

In patients with STEMI who undergo primary PCI, we found a change in leukocyte profile during the first 24 hours after hospital admission, and the leukocyte profile at 24 hours after admission was correlated with clinical outcomes. Among leukocyte profiles, the 24-hour NLR best predicted mortality; patients with 24-hour NLRs ≥5.44 had 3.12-fold increased risk for death.

There are few reports of an association between baseline leukocyte profile in patients with acute myocardial infarctions and

Disclosures

The authors have no conflicts of interest to disclose.

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