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Atherosclerosis is an inflammatory process where leucocytes and subgroups play an important role. Recently neutrophile to lymphocyte ratio has been suggested as a predictor of morbidity and mortality in patients with coronary artery disease. We aimed to investigate if there is any relation between neutrophile to lymphocyte ratio (N/L ratio) with angiographically determined extent, severity, complexity of coronary artery disease and myocardial perfusion.
We consecutively involved 151 patients who were admitted with stable angina pectoris or acute coronary syndrome and who were decided to undergo coronary angiography. Blood samples were drawn before coronary angiography for complete blood count analysis to assess neutrophile and lymphocyte counts, and N/L ratio. Gensini score and SYNTAX score were calculated to assess extent, severity and complexity of coronary artery disease. Myocardial blush grade was used to evaluate myocardial perfusion.
There were 93 patients in the stable angina group and 58 patients in the acute coronary syndrome group. Groups were similar with respect to baseline demographic, clinic and laboratory parameters (Table 1). Neutrophile counts were 4,4±1,4 and 5,0±1,6 in the stable angina and acute coronary syndrome groups respectively (p:0,018); whereas lymphocyte counts were 2,2±0,7 and 2,1±0,7 respectively (p:0,104). Neutrophile to lymphocyte ratio was 2,2±1,2 in the stable angina group and 2,6±1,0 in the acute coronary syndrome group (p:0,002). N/L ratio was significantly associated with Gensini and SYNTAX scores (r:0,469 and r:0,458 respectively; p<0,001 for both). This association remained significant after adjustment for age and total leucocyte count (adjusted OR: 1,968 %95 CI (1,301-2,975), p:0,001). According to Kruskal Wallis analysis, there was a significant association between MBG and N/L ratio (p<0,001). Cut off value of N/L ratio to predict moderate to severe CAD according to SYNTAX score was 2,26 (Figure 1).
Neutrophile to lymphocyte ratio is associated with severe and extensive coronary artery disease and it may be used to predict moderate to severe involvement in patients with coronary artery disease.
|SAP (N:93)||ACS (N:58)||p value|
Baseline characteristics of the study population. p<0,05 is considered significant. SAP:stable angına pectoris, ACS: acute coronary syndrome, BMI:body mass index, WC:waist circumference, HT:hypertension, DM: diabetes mellitus, FH:family history, HPL: hyperlipidemia