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Several studies had demonstrated that there is an association between neutrophil to lymphocyte ratio (NLR) and the severity, non-calcified plaque burden and coronary artery calcium score of coronary atherosclerosis. Patients with non-calcified or mix plaques had a higher risk of adverse outcomes. However, there is no published data on the relationship between NLR and presence of non-calcified or mixed coronary atherosclerotic plaques in Chinese population. The aim of this study was to investigate whether neutrophil to lymphocyte ratio (NLR) is related to the presence of non-calcified or mixed coronary atherosclerotic plaques in Chinese population undergoing coronary computed tomography angiography (CCTA).
We retrospectively collected the clinical and laboratory data of 598 consecutive subjects undergoing CCTA with chest pain. Coronary plaques were classified as calcified, non-calcified and mixed. If the patients had one more type of plaques, the most stenotic plaque was recorded. In this study, the subjects were divided into three groups according to the type of plaques. There were 167 subjects who had no coronary plaques (NP), 219 patients with calcified plaques (CP), 134 patients with non-calcified plaques (NCP) and 78 patients with mixed plaques (NCP). Given that the number of cases in NCP (n=134) and MP (n=78) were not sufficient. Patients with NCPs and MPs had a high risk of adverse outcomes; therefore, the two groups were merged (NCP &MP) for analysis.
Neutrophils and NLR were significant different (p < 0.05) across the three groups, while high-sensitivity C-reactive protein (hs-CRP) was not (p = 0.057). Subjects with NLR > 2.21 had a higher proportion of NCP & MP compared the subjects with NLR < 1.55. In contrast, the subjects with NP were more prone to be divided into NLR ≤ 2.21 group (74.8% vs. 25.2%, p < 0.05). Spearman correlation analysis showed that NLR was positively correlated with hs-CRP (r = 0.177, p <0.001). Multiple logistic regression analysis showed that NLR was an independent risk factor for the presence of NCP & MP (OR: 1.201； 95% CI: 1.019-1.416; p =0.029), whereas hs-CRP was not.
NLR is independently associated with the presence of non-calcified or mixed coronary atherosclerotic plaques in Chinese population undergoing CCTA. The findings highlight the potential value of these easily and cheap measured factors in predicting the presence of non-calcified and mixed plaques and monitoring of CAD patients.