Platelet-to-Lymphocyte Ratio Improves the Predictive Power of GRACE Risk Score for Long-Term Cardiovascular Events in Patients with Acute Coronary Syndrome

Abstract

Objectives: This study aims to evaluate the relationship between platelet-to-lymphocyte ratio (PLR) and GRACE risk score and to examine whether PLR on admission can improve the predictive value of GRACE risk score for cardiovascular disease (CVD) events in patients with acute coronary syndrome (ACS). Methods: PLR was calculated from the platelet and lymphocyte counts from the complete blood count of 2,230 ACS patients upon admission. The GRACE risk score was also calculated. Results: Spearman's rank correlation demonstrated that GRACE risk score was positively correlated with PLR (r = 0.190, p < 0.001). After a median follow-up period of 58 months, multivariate Cox analysis showed that both GRACE risk score [hazard ratio (HR) 1.092, 95% confidence interval (CI) 1.067-1.117, p < 0.001] and PLR (HR 1.100, 95% CI 1.088-1.112, p < 0.001) could independently predict CVD events. Receiver-operating characteristic curve (ROC) analysis proved that using PLR together with GRACE risk score improved the score from 0.70 (95% CI 0.67-0.73, p < 0.001) when used alone to 0.81 (95% CI 0.79-0.83, p < 0.001) for CVD events and from 0.73 (95% CI 0.70-0.77, p < 0.001) when used alone to 0.80 (95% CI 0.77-0.83, p < 0.001) for all-cause mortality. Conclusions: This study proves, for the first time, a positive association between GRACE risk score and PLR, and that a combination of PLR and GRACE risk score is more effective in predicting CVD events in ACS patients.

Platelet to lymphocyte ratio in the prediction of adverse outcomes after acute coronary syndrome: a meta-analysis

“…Zhou et al . showed a positive association between GRACE risk score and PLR8. The PLR was also reported to be significantly correlated with other inflammatory markers such as C-reactive protein (CRP) and fibrinogen, which have been demonstrated to have predictive and prognostic significance in cardiovascular diseases39.…”

“…The inclusion criteria were listed as follows: (1) All patients were diagnosed as ACS, including acute ST elevation myocardial infarction, acute non-ST elevation myocardial infarction and unstable angina8. (2) Blood samples for PLR determination were taken at admission.…”

“…Zhou et al . demonstrated that PLR was positively associated with the Global Registry of Acute Coronary Events (GRACE) risk score and can improve its the predictive power for long-term cardiovascular events in patients with ACS8. Temiz et al .…”

Ticagrelor and prasugrel are independent predictors of improved long‐term survival in ACS patients

“…32,33 Studies showed that higher values of PLR were associated with an increased occurrence of cardiovascular events in patients after ACS. 34,35 Of interest, the main predictor of long-term mortality was age, which is a constant finding. 36 The second predictor of mortality was the type of the used P2Y12 inhibitor underlining its importance even with regard to long-term outcomes.…”

Incorporating the erythrocyte sedimentation rate for enhanced accuracy of the global registry of acute coronary event score in patients with ST-segment elevated myocardial infarction

“…Chronic inflammatory processes are related to the pathogenesis and extension of atherosclerosis in coronary artery disease. [ 7 ] Several studies show that inflammatory markers, such as C-reactive protein (CRP), [ 8 , 9 ] neutrophil counts, [ 10 ] mean platelet volume, [ 11 ] platelet-to-lymphocyte ratio, [ 12 ] and neutrophil-to-lymphocyte ratio, [ 13 , 14 ] correlate with GRS and adversely predict short- and long-term prognosis. However, none of these works demonstrates the independent predictive value of the erythrocyte sedimentation rate (ESR) on clinical adverse outcomes.…”