Relationship between Neutrophil-To-Lymphocyte Ratio and Electrocardiographic Ischemia Grade in STEMI

Abstract

BackgroundNeutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Changes in the QRS terminal portion have also been associated with adverse outcomes following STEMI.ObjectiveTo investigate the relationship between ECG ischemia grade and NLR in patients presenting with STEMI, in order to determine additional conventional risk factors for early risk stratification.MethodsPatients with STEMI were investigated. The grade of ischemia was analyzed from the ECG performed on admission. White blood cells and subtypes were measured as part of the automated complete blood count (CBC) analysis. Patients were classified into two groups according to the ischemia grade presented on the admission ECG, as grade 2 ischemia (G2I) and grade 3 ischemia (G3I).ResultsPatients with G3I had significantly lower mean left ventricular ejection fraction than those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital mortality rate increased proportionally with the increase in ischemia grade (p = 0.036). There were significant differences in percentage of lymphocytes (p = 0.010) and percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis revealed that only NLR was the independent variable with a significant effect on ECG ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120–1.403, p < 0.001).ConclusionWe found an association between G3I and elevated NLR in patients with STEMI. We believe that such an association might provide an additional prognostic value for risk stratification in patients with STEMI when combined with standardized risk scores.

Correlation between neutrophil to lymphocyte ratio (NLR) and red cell distribution width to platelet ratio with ST segment resolution and 2 month complications in patients with acute myocardial infarction undergoing primary coronary intervention

“…Our study revealed that among 211 patients, 181 of them (85.8%) were male and 30 of them (14.2%) were female which is accordance with the results of other studies which report that acute myocardial infarction happens more in men compared to women (16)(17)(18)(19)(20)(21)(22).…”

“…In a study carried out in turkey it was shown that NLR was significantly higher in patients with grade 3 ischemia. The researchers in this article believe that it is possible to use NLR as a prognostic and risk assessment index in patients with acute myocardial infarction in near future (20), which is in correspondence with the results of our manuscript.…”

“…In another study conducted in Japan the age average was reported to be 66±1 (19). in most performed studies, acute myocardial infarction happened in 60s in majority of patients (20)(21)(22). Based on reported data it seems that acute myocardial infarction happens mostly in 60s and early 70s of age.…”

Neutropenia and neutrophil‐to‐lymphocyte ratio in a healthy Korean population: race and sex should be considered

“…Several studies demonstrated that NLR is a significant predictor of adverse outcomes for patients with conditions such as acute cholecystitis, cardiovascular disease, cerebrovascular disease, malignancies, and sudden sensorineural hearing loss . In rheumatoid arthritis, NLR correlates with the disease activity score and high values are associated with chronic conditions such as diabetes, as well as with smoking and increased age .…”

“…The neutrophil‐to‐lymphocyte ratio (NLR), calculated as ANC divided by absolute lymphocyte count (ALC), is a powerful parameter for predicting the prognosis or severity of disease . NLR is believed to reflect the balance between the innate (neutrophils) and adaptive (lymphocytes) immune responses, and elevated values are associated with cellular DNA damage .…”