Combination of White Blood Cell Count to Mean Platelet Volume Ratio and Neutrophil-to-Platelet Ratio Predicts Long-Term Adverse Events in Patients with MINOCA

Abstract

Background. White blood cell count to mean platelet volume ratio (WMR) and neutrophil-to-platelet ratio (NPR) have been demonstrated as prognostic inflammatory biomarkers of the acute coronary syndrome. We aimed to evaluate the prognostic value of WMR and NPR among myocardial infarction with nonobstructive coronary arteries (MINOCA) patients. Method. A total of 274 MINOCA patients were enrolled. Baseline clinical data, blood cell panel, and biochemical parameters were evaluated. The patients were classified according to the medians of WMR and NPR. The primary endpoint of the present study was major adverse cardiovascular events (MACE). Multivariable Cox regression analysis was used to assess the effect of independent variables of WMR and NPR on the dependent variable (MACE). Result. The median values of WMR and NPR were 701 and 0.03, respectively. During the median follow-up of 28 months, a total of 58 incidences of MACE occurred. The MACE rate was more frequent in high WMR and high NPR patients. In Kaplan-Meier analysis, the incidence of MACE was higher in WMR>701 and NPR>0.03 (long-rank P = 0.004 and P = 0.002 , respectively). The combined high WMR and high NPR showed a significantly higher rate of MACE (long-rank P = 0.001 ). Cox regression analysis showed that the combined high WMR and high NPR were independent predictors of long-term MACE with the highest hazard ratio (HR, 2.511; 95% CI, 1.271 to 4.960; P = 0.008 ). Conclusion. High WMR and NPR separately or in combination were correlated with increased risk of MACE among MINOCA patients, suggesting WMR and NPR may assist as a reliable inflammatory marker in risk prediction of MINOCA patients.

MINOCA: A Working Diagnosis

“…White blood cell count to mean platelet-volume ratio (WMR) and neutrophil-to-platelet ratio (NPR) are inflammatory biomarkers that have been shown to predict clinical outcomes in patients presenting with acute MI. Mohammed et al's study revealed that this correlation is also present in MINOCA, and patients with high WMR and NPR were at increased risk of MACE [ 11 ]. They are pointing to the possible use of these ratios as risk prediction markers in the clinical assessment of MINOCA patients.…”

Mean platelet volume, platelet count, and neutrophil/lymphocyte ratio in drug-naïve patients with schizophrenia: a cross-sectional study

“…Another indicator of systemic inflammation is the neutrophil/lymphocyte ratio, established as an indicator of strong systemic inflammation associated with mortality and adverse cardiac events, a study that analyzed the combination of high neutrophil/lymphocyte ratio and high mean platelet volume concluded that it independently predicts major adverse cardiovascular events in patients with coronary syndrome ( 13 ). Thus, both MPV and NLR can be used as biomarkers of inflammation as predictors of adverse arterial events due to atheroma plaque formation ( 14 ).…”

Effect of inflammatory factors on myocardial infarction

“…Other in ammatory markers of myocardial injury include the following: A high white blood cell count to mean platelet volume ratio and neutrophil-to-platelet ratio, separately or in combination, have been associated with an increased risk of major adverse cardiovascular events in patients [7]. Moreover, the peak level of C-reactive protein (CRP) can serve as a predictive marker for transmural MI, and its predictive ability is comparable to that of peak creatine kinase-Myocardial Band (CK-MB) and highsensitivity cardiac troponin T levels [8].…”