Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Neutrophil to Lymphocyte Ratio Predicts Long-Term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

  • Han, Yang-Chun (Division of Cardiology, Department of Internal Medicine, Changwon Fatima Hospital) ;
  • Yang, Tae-Hyun (Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Inje University College of Medicine, Busan Paik Hospital) ;
  • Kim, Doo-Il (Cardiovascular Research Institute, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Jin, Han-Young (Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Inje University College of Medicine, Busan Paik Hospital) ;
  • Chung, Sang-Ryul (Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Inje University College of Medicine, Busan Paik Hospital) ;
  • Seo, Jeong-Sook (Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Inje University College of Medicine, Busan Paik Hospital) ;
  • Jang, Jae-Sik (Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Inje University College of Medicine, Busan Paik Hospital) ;
  • Kim, Dae-Kyeong (Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Inje University College of Medicine, Busan Paik Hospital) ;
  • Kim, Dong-Kie (Cardiovascular Research Institute, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Kim, Ki-Hun (Cardiovascular Research Institute, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Seol, Sang-Hoon (Cardiovascular Research Institute, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Kim, Dong-Soo (Division of Cardiology, Department of Internal Medicine, Cardiovascular Research Institute, Inje University College of Medicine, Busan Paik Hospital)
  • Published : 2013.02.28
⟨ Previous Next ⟩

Abstract

Background and Objectives: A higher neutrophil to lymphocyte ratio (NLR) has been associated with poor clinical outcomes in various cardiac diseases. However, the clinical availability of NLR in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been known. We evaluated the availability of NLR to predict clinical outcomes in patients with STEMI undergoing primary PCI. Subjects and Methods: We analyzed 326 consecutive STEMI patients treated with primary PCI. The patients were divided into tertiles according to NLR: NLR${\leq}3.30(n=108)$, 3.31${\leq}6.52(n=108)$ and NLR>6.53 (n=110). We evaluated the incidence of major adverse cardiac events (MACE), a composite of all causes of death, non-fatal MI, and ischemic stroke at the 12-month follow-up. Results: The high NLR group was associated with a significantly higher rate of 12-month MACE (19.1% vs. 3.7%, p<0.001), 12-month death (18.2% vs. 2.8%, p<0.001), in-hospital MACE (12.7% vs. 2.8%, p=0.010) and in-hospital death (12.7% vs. 1.9%, p=0.003) compared to the low NLR group. In the multivariable model, high NLR was an independent predictor of 12-month MACE {hazard ratio (HR) 3.33 (1.09-10.16), p=0.035} and death {HR 4.10 (1.17-14.46), p=0.028} after adjustment for gender, left ventricular ejection fraction, creatinine clearance, angiographic parameters and factors included in the Thrombolysis in Myocardial Infarction risk score for STEMI. There was a significant gradient of 12-month MACE across the NLR tertiles with a markedly increased MACE hazard in the high NLR group (log rank test p=0.002). Conclusion: The NLR is a useful marker to predict 12-month MACE and death in patients with STEMI who have undergone primary PCI.

Keywords

References

  1. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340:115-26. https://doi.org/10.1056/NEJM199901143400207
  2. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105:1135-43. https://doi.org/10.1161/hc0902.104353
  3. Hoffman M, Blum A, Baruch R, Kaplan E, Benjamin M. Leukocytes and coronary heart disease. Atherosclerosis 2004;172:1-6. https://doi.org/10.1016/S0021-9150(03)00164-3
  4. Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45: 1638-43. https://doi.org/10.1016/j.jacc.2005.02.054
  5. Gibson PH, Croal BL, Cuthbertson BH, et al. Preoperative neutrophillymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007;154:995-1002. https://doi.org/10.1016/j.ahj.2007.06.043
  6. Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of neutrophil/ lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2010;105:186-91. https://doi.org/10.1016/j.amjcard.2009.09.007
  7. Uthamalingam S, Patvardhan EA, Subramanian S, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011;107:433-8. https://doi.org/10.1016/j.amjcard.2010.09.039
  8. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting longterm mortality after percutaneous coronary intervention. Am J Cardiol 2006;97:993-6. https://doi.org/10.1016/j.amjcard.2005.10.034
  9. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102:653-7. https://doi.org/10.1016/j.amjcard.2008.05.006
  10. Azab B, Zaher M, Weiserbs KF, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol 2010;106:470-6. https://doi.org/10.1016/j.amjcard.2010.03.062
  11. Nunez J, Nunez E, Bodi V, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;101:747-52. https://doi.org/10.1016/j.amjcard.2007.11.004
  12. Furman MI, Becker RC, Yarzebski J, Savegeau J, Gore JM, Goldberg RJ. Effect of elevated leukocyte count on in-hospital mortality following acute myocardial infarction. Am J Cardiol 1996;78:945-8. https://doi.org/10.1016/S0002-9149(96)00473-0
  13. Furman MI, Gore JM, Anderson FA, et al. Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 2004;147:42-8. https://doi.org/10.1016/j.ahj.2003.07.003
  14. Barron HV, Cannon CP, Murphy SA, Braunwald E, Gibson CM. Association between white blood cell count, epicardial blood flow, myocardial perfusion, and clinical outcomes in the setting of acute myocardial infarction: a thrombolysis in myocardial infarction 10 substudy. Circulation 2000;102:2329-34. https://doi.org/10.1161/01.CIR.102.19.2329
  15. Ott I, Neumann FJ, Kenngott S, Gawaz M, Schomig A. Procoagulant inflammatory responses of monocytes after direct balloon angioplasty in acute myocardial infarction. Am J Cardiol 1998;82:938-42. https://doi.org/10.1016/S0002-9149(98)00509-8
  16. Lee HY, Kim JH, Kim BO, et al. Effect of aspiration thrombectomy on microvascular dysfunction in ST-segment elevation myocardial infarction with an elevated neutrophil count. Korean Circ J 2011;41:68-75. https://doi.org/10.4070/kcj.2011.41.2.68
  17. Kirtane AJ, Bui A, Murphy SA, Barron HV, Gibson CM. Association of peripheral neutrophilia with adverse angiographic outcomes in ST-elevation myocardial infarction. Am J Cardiol 2004;93:532-6. https://doi.org/10.1016/j.amjcard.2003.11.013
  18. Baldus S, Heeschen C, Meinertz T, et al. Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes. Circulation 2003;108:1440-5. https://doi.org/10.1161/01.CIR.0000090690.67322.51
  19. Tousoulis D, Antoniades C, Koumallos N, Stefanadis C. Pro-inflammatory cytokines in acute coronary syndromes: from bench to bedside. Cytokine Growth Factor Rev 2006;17:225-33. https://doi.org/10.1016/j.cytogfr.2006.04.003
  20. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol 1997;79:812-4. https://doi.org/10.1016/S0002-9149(96)00878-8
  21. Widmer A, Linka AZ, Attenhofer Jost CH, et al. Mechanical complications after myocardial infarction reliably predicted using C-reactive protein levels and lymphocytopenia. Cardiology 2003;99:25-31. https://doi.org/10.1159/000068448
  22. Blum A, Sclarovsky S, Rehavia E, Shohat B. Levels of T-lymphocyte subpopulations, interleukin-1 beta, and soluble interleukin-2 receptor in acute myocardial infarction. Am Heart J 1994;127:1226-30. https://doi.org/10.1016/0002-8703(94)90040-X
  23. Cho KH, Jeong MH, Ahmed K, et al. Value of early risk stratification using hemoglobin level and neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2011;107:849-56. https://doi.org/10.1016/j.amjcard.2010.10.067

Cited by

  1. The relationship between the neutrophil–lymphocyte ratio and the coronary collateral circulation in patients with chronic total occlusion vol.29, pp.4, 2013, https://doi.org/10.1177/0267659114521102
  2. Superiority of total white blood cell count over other leukocyte differentials for predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome vol.19, pp.5, 2013, https://doi.org/10.3109/1354750x.2014.915429
  3. Neutrophil/lymphocyte ratio is related to the severity of idiopathic dilated cardiomyopathy vol.48, pp.4, 2014, https://doi.org/10.3109/14017431.2014.932922
  4. T lymphocytes and fractalkine contribute to myocardial ischemia/reperfusion injury in patients vol.125, pp.8, 2013, https://doi.org/10.1172/jci80055
  5. Can Admission Neutrophil to Lymphocyte Ratio Predict Infarct-Related Artery Patency in ST-Segment Elevation Myocardial Infarction vol.21, pp.2, 2013, https://doi.org/10.1177/1076029613515071
  6. Combined Usefulness of the Platelet-to-Lymphocyte Ratio and the Neutrophil-to-Lymphocyte Ratio in Predicting the Long-Term Adverse Events in Patients Who Have Undergone Percutaneous Coronary Intervent vol.10, pp.7, 2015, https://doi.org/10.1371/journal.pone.0133934
  7. Relationship between white blood cells and hypertension in Chinese adults: The Cardiometabolic Risk in Chinese (CRC) study vol.37, pp.7, 2013, https://doi.org/10.3109/10641963.2015.1036058
  8. Impact of neutrophil-to-lymphocyte ratio on periprocedural myocardial infarction in patients undergoing non-urgent percutaneous coronary revascularisation vol.24, pp.7, 2013, https://doi.org/10.1007/s12471-016-0850-6
  9. Neutrophil to Lymphocyte Ratio and the Extent of Coronary Artery Disease : Results From a Large Cohort Study vol.67, pp.1, 2013, https://doi.org/10.1177/0003319715577529
  10. Behaviour of the neutrophil to lymphocyte ratio in young subjects with acute myocardial infarction vol.62, pp.3, 2013, https://doi.org/10.3233/ch-151968
  11. Inflammatory markers in ST-elevation acute myocardial infarction vol.5, pp.4, 2013, https://doi.org/10.1177/2048872615568965
  12. Association of the Neutrophil-to-Lymphocyte Ratio with Lung Function and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease vol.11, pp.6, 2013, https://doi.org/10.1371/journal.pone.0156511
  13. Bilirubin Levels and Thrombus Burden in Patients With ST-Segment Elevation Myocardial Infarction vol.67, pp.6, 2013, https://doi.org/10.1177/0003319715603899
  14. Prognostic Value of Circulating Inflammatory Cells in Patients with Stable and Acute Coronary Artery Disease vol.4, pp.None, 2017, https://doi.org/10.3389/fcvm.2017.00044
  15. A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index vol.27, pp.5, 2013, https://doi.org/10.1016/j.numecd.2017.01.005
  16. Increased maximum p wave duration in smoking patients with ST-elevation acute myocardial infarction and its relationship with inflammatory markers vol.59, pp.3, 2013, https://doi.org/10.1016/j.crvasa.2016.10.005
  17. Classification of New Biomarkers of Dilated Cardiomyopathy Based on Pathogenesis-An Update vol.10, pp.3, 2013, https://doi.org/10.4236/health.2018.103024
  18. Prognostic Value of Neutrophil to Lymphocyte Ratio for In-hospital Mortality in Elderly Patients with Acute Myocardial Infarction vol.38, pp.2, 2013, https://doi.org/10.1007/s11596-018-1887-0
  19. NEUTROPHIL-TO-LYMPHOCYTE RATIO AS A MARKER OF ACUTE EXACERBATION AND DISEASE SEVERITY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE vol.7, pp.43, 2013, https://doi.org/10.14260/jemds/2018/1038
  20. Predictive value of neutrophil to lymphocyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis vol.18, pp.None, 2018, https://doi.org/10.1186/s12872-018-0812-6
  21. Correlation between neutrophil count and prognosis in STEMI patients with chronic renal dysfunction: a retrospective cohort study vol.14, pp.1, 2013, https://doi.org/10.1515/biol-2019-0075
  22. Correlation between neutrophil count and prognosis in STEMI patients with chronic renal dysfunction: a retrospective cohort study vol.14, pp.1, 2013, https://doi.org/10.1515/biol-2019-0075
  23. Neutrophil to Lymphocyte Ratio as a Prognostic Predictor in Older People With Acute Coronary Syndrome vol.70, pp.3, 2019, https://doi.org/10.1177/0003319718796565
  24. Combination of Mean Platelet Volume and Neutrophil to Lymphocyte Ratio Predicts Long-Term Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention vol.70, pp.4, 2019, https://doi.org/10.1177/0003319718768658
  25. The relationship between chronic obstructive pulmonary disease and non‐small cell lung cancer in the elderly vol.8, pp.9, 2013, https://doi.org/10.1002/cam4.2333
  26. Neutrophil-to-lymphocyte ratio for predictor of in-hospital mortality in ST-segment elevation myocardial infarction: a meta-analysis vol.29, pp.2, 2013, https://doi.org/10.13181/mji.oa.202795
  27. Addition of routine blood biomarkers to TIMI risk score improves predictive performance of 1-year mortality in patients with ST-segment elevation myocardial infarction vol.20, pp.1, 2013, https://doi.org/10.1186/s12872-020-01777-7
  28. The Role of Neutrophil Lymphocyte Ratio as a Major Adverse Cardiac Events Predictor and Its Correlation with Coronary Severity in Acute Coronary Syndrome Patients with Chronic Kidney Disease: A Case C vol.9, pp.2, 2020, https://doi.org/10.3889/oamjms.2021.7488
  29. Prognostic Utility of the Combination of Platelet Count with Neutrophil-to-Lymphocyte Ratio in Aged Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention vol.2021, pp.None, 2021, https://doi.org/10.1155/2021/4023472
  30. Performance of neutrophil to lymphocyte ratio for the prediction of long-term morbidity and mortality in coronary slow flow phenomenon patients presented with non-ST segment elevation acute coronary s vol.13, pp.2, 2013, https://doi.org/10.34172/jcvtr.2021.12