Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome

Abstract

Objective: Inflammatory mechanisms are known to play an important role in coronary artery disease. The present study aimed to investigate the importance of the neutrophil-to-lymphocyte ratio (NLR) in terms of in-hospital mortality and its association with currently used risk scores in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods: Three hundred and seventeen patients with NSTE-ACS were included. The patients were divided into tertiles according to their NLR values (NLR <2.6, NLR=2.6---4.5, and NLR >4.5). Clinical and angiographic risk was evaluated by the SYNTAX and GRACE risk scores. Results: The GRACE risk score was significantly higher in the group with high NLR values compared to those with moderate or low NLR (161.5±40.3, 130.5±32.3, and 123.9±34.3, respectively, p<0.001). Similarly, the SYNTAX score was significantly higher in the group with high NLR values (20.4±10.1, 15.5±10.5, and 13.4±7.8, respectively, p=0.003). Moreover, both GRACE (r=0.457, p<0.001) and SYNTAX scores (r=0.253, p=0.001) showed a significant positive correlation with NLR. Conclusion: NLR has been found to be correlated with clinical and angiographic risk scores. Low NLR might be a good predictor for low in-hospital mortality and simple coronary anatomy in NSTE-ACS patients.Síndrome coronária aguda sem elevação do segmento ST; Rácio neutrófilo/linfócito; Score SYNTAX; Score GRACE Rácio neutrófilo-linfócito prevê a complexidade da lesão arterial coronária e a mortalidade após o enfarte do miocárdio sem elevação do segmento ST ResumoObjetivos: Sabe-se que os mecanismos inflamatórios têm um papel importante na doença arterial coronária. O presente estudo visa investigar a importância do rácio neutrófilo/linfócito (RNL) relativamente à mortalidade hospitalar e à sua associação com os scores de risco atuais em doentes com síndromes coronárias agudas sem elevação do segmento-ST (SCA-NSTE). Métodos: Foram incluídos 317 doentes com SCA-NSTE. Os doentes foram divididos em tercis de acordo com os seus valores de RNL (RNL < 2,6, RNL = 2,6-4,5 e RNL > 4,5). Os scores de risco clínicos e angiográficos foram avaliados pelos métodos de risco SYNTAX e GRACE. Resultados: O score de risco GRACE foi significativamente mais elevado no grupo com valores RNL elevados comparado com os grupos com RNL moderado ou baixo (161,5 ± 40,3, 130,5 ± 32,3 e 123,9 ± 34,3, respetivamente, p<0,001). Do mesmo modo, o score SYNTAX foi significativamente superior no grupo com valores RNL elevados (20,4 ± 10,1, 15,5 ± 10,5 e 13,4 ± 7,8, respetivamente, p=0,003). Por outro lado, tanto o score de risco GRACE (r=0,457, p<0,001) como o score SYNTAX (r=0,253, p=0,001) mostraram uma correlação positiva significativa com RNL. Conclusão: Verificou-se que o RNL está correlacionado com os scores de risco clínicos e angiográficos. Um RNL baixo pode ser um bom fator preditor de mortalidade intra-hospitalar e de anatomia coronária simples em doentes com enfarte do miocárdio sem elevação do segmento ST.

The relationship between corrected QT interval and neutrophil to lymphocyte ratio in patients with acute coronary syndrome

“…Neutrophils are thought to be the first to accumulate [13]. They have several functions such as regulating and enhancing the inflammatory process by increasing their numbers in this region and causing the release of various mediators such as prothrombotic, proteolytic enzymes and oxidant substances, while lymphocytes decrease in number because of glucocorticoids secreted due to increased stress response [13,14]. NLR represents a combination of neutrophils and lymphocytes, which are components of two independent inflammatory reactions.…”

Assessment of Relationship Between SYNTAX and SYNTAX II Scores and Neutrophil/Lymphocyte Ratio in Patients with Non-ST Segment Elevation Myocardial Infarction

“…Daha önce NSTEMI hastalarında NLR'nin değerlendirildiği çalışmalarda; bizim çalış-mamıza göre NLR oldukça daha yüksek bulunmuştu. Ayrıca hastaların troponin değerleri ile CRP değerleri bu çalışmaya göre oldukça yüksek bulunmuş olmasına rağmen 16,26 , Soylu ve ark. yaptığı çalışmada SS (16,44), bizim çalışmamızdaki ortalama SS skoruna yakın bulunmuştur 16 .…”

“…Ayrıca hastaların troponin değerleri ile CRP değerleri bu çalışmaya göre oldukça yüksek bulunmuş olmasına rağmen 16,26 , Soylu ve ark. yaptığı çalışmada SS (16,44), bizim çalışmamızdaki ortalama SS skoruna yakın bulunmuştur 16 . Troponin yüksekliğinin daha belirgin inflamasyon ile ilişkili olduğu bilinmektedir 27,28 .…”

Importance of neutrophil-to-lymphocyte ratio in coronary artery disease

“…The inflammation mediated by neutrophils leads to further tissue damage via several biochemical mechanisms (2). The neutrophil-to-lymphocyte ratio is an inflammatory marker that has been demonstrated to correlate with severity of coronary artery disease in acute coronary syndromes (3)(4)(5). However, independent studies may have resulted either in favor of or opposite of previous researchers therefore, despite our inconsistent results with literature we have rather preferred to publish our study in order to be free from bias.…”