Association of lymphocyte-to-monocyte ratio with the long-term outcome after hospital discharge in patients with ST-elevation myocardial infarction: a retrospective cohort study

Abstract

Objective Lymphocyte-to-monocyte ratio (LMR), a novel systemic inflammatory factor, correlates with adverse outcomes in patients with cardiovascular disease. However, data are limited regarding the prognostic value of LMR in patients with ST-elevation myocardial infarction (STEMI) after hospital discharge. Therefore, the aim of our study was to evaluate the prognostic impact of admission LMR in hospital survivors of STEMI. Methods This retrospective observational study enrolled 1369 STEMI patients between 2014 and 2017. The study population was divided into three groups according to tertiles (T) of LMR (T1: ≥2.84; T2: 1.85–2.83; T3: <1.85). The primary outcomes were long-term outcomes after discharge including major adverse cardiac events (MACE) and all-cause mortality. The associations between LMR and long-term outcomes were assessed using Cox regression analysis. Results The median follow-up period was 556 days (interquartile range, 342–864 days). Independent correlations were observed between LMR and both long-term MACE and all-cause mortality. For long-term MACE, the T3 (adjusted hazard ratio [HR], 1.74; 95% confidence interval [CI]: 1.12–2.70; P = 0.013) and T2 groups (adjusted HR, 1.65; CI: 1.07–2.54; P = 0.024) showed significantly higher risk of MACE than did the T1 group. For long-term all-cause mortality, the adjusted HR was 3.07 (CI: 1.10–8.54; P = 0.032) in the T3 group and 2.35 (CI: 0.82–6.76; P = 0.112) in the T2 group compared with that of the T1 group. Conclusion Decreased admission LMR was independently associated with long-term all-cause mortality and MACE after discharge in patients with STEMI.

The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: A systematic review and meta-analysis

“…In this meta-analysis, we enrolled 5 studies comprising 4343 patients to investigate the prognostic value of the LMR in patients with ACS [18,[21][22][23][24]. The present study showed that LMR might be a predictor for short-term mortality/MACE.…”

“…The result showed that LMR predicted short-term mortality/MACE (HR = 3.44, 95% CI: 1.46-8.14, P < 0.05, Figure 2A), with low levels of heterogeneity among studies (I 2 = 0%). The combined analysis of 5 studies covering 4343 patients described the relationship between LMR and longterm mortality/MACE [18,[21][22][23][24]. The pooled outcome for low LMR value compared with high LMR value group was found to be 1.70 (95% CI: 1.36-2.13, P < 0.05, Figure 2B), with moderate levels of heterogeneity among studies (I 2 = 46.8%).…”

The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: A systematic review and meta-analysis

“…These studies were all observation researchers and one conducted in Netherlands [18], one conducted in Turkey [21], three conducted in China [22][23][24]. The mean age of the patients ranges from 60.77 to 65.12 years old.…”

“…The mean age of the patients ranges from 60.77 to 65.12 years old. Two studies in this meta-analysis enrolled STEMI patients [21,24], two studies enrolled NSTEMI patients [22,23], and the remaining one study enrolled ACS patients [18]. Two of studies explicitly stated that the patients underwent PCI [21,22], while others did not specify if enrolled patients underwent PCI [18,23,24].…”

“…Two studies in this meta-analysis enrolled STEMI patients [21,24], two studies enrolled NSTEMI patients [22,23], and the remaining one study enrolled ACS patients [18]. Two of studies explicitly stated that the patients underwent PCI [21,22], while others did not specify if enrolled patients underwent PCI [18,23,24]. Two studies reported the mortality [18,21], and three studies reported MACE [22][23][24].…”