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Neutrophil-to-lymphocyte ratio (NLR) has been proposed as a marker of cardiovascular risk. The prognostic value of NLR in patients with acute myocardial infarction (AMI) who undergo primary percutaneous coronary intervention (pPCI) is not clearly defined. We sought to determine the association of the NLR with clinical outcomes in patients with AMI in a large prospective study.
Patients (n=1920) admitted with AMI and who undergo pPCI between January 2013 and December 2013 were followed up for two years. Patients were divided into tertiles according to NLR on admission. The primary end point was all-cause death. The secondary end point was long-term major adverse cardiovascular and cerebrovascular events (MACCEs). We used Cox regression models to examine the relation between NLR and clinical outcomes.
During the follow-up period, the prevalence of all-cause mortality, cardiac death and MACCEs were higher in the third NLR tertile group (p<0.001 for all). The best cut-off value of admission NLR to predict all-cause mortality was 3.19 (area under the curve 0.766, 95% confidence interval [CI] 0.69 to 0.84). In multivariate analysis, after adjusting for risk factors, a NLR value in the highest tertile was determined as an independent predictor of all-cause mortality (hazard ratio 5.51, 95% CI 1.25 to 24.26, p=0.024) and MACCEs (hazard ratio 1.45, 95% CI 1.06 to 1.99, p=0.022). Kaplan-Meier survival analysis revealed a higher two years mortality in the highest NLR group compared to the lower NLR group (4.1% vs 0.2%, p<0.001). The NLR was significantly and positively correlated with high-sensitivity C-reactive protein (hsCRP) levels (r=0.322, p<0.001).
The admission NLR is a useful marker of inflammatory and prothrombotic status and predicted long-term all-cause mortality and MACCEs in patients with AMI who have undergone primary PCI. This relatively inexpensive marker of inflammation can aid in the risk stratification and prognosis of patients diagnosed with AMI.