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We aimed to assess relationship between neutrophil-to-lymphocyte ratio (NLR), monocyte count and the severity of coronary lesions in patients with myocardial infarction (MI), complicated by cardiogenic shock.
61 patients (27 (44%) men and 34 (56%) women) with MI complicated by cardiogenic shock were recruited. All patients underwent coronary angiography. The severity of coronary artery lesions was evaluated by Syntax Score I. Patients were divided into two groups depending on the outcome: group 1 - died (31 patients, 51%); group 2 - survivors (30 patients; 49%). NLR was calculated as the ratio of the mean neutrophil count to mean lymphocyte count. Statistical analyzes were performed with Statistica 10.0.
Mean age of patients was 72.5 ± 2.1 years. No age differences were found between the groups. There were significantly more females in 1 group (70% vs 40% in group 2, p = 0.03). Patients with ST-segment elevation myocardial infarction were met equally often (82% in group 1 and 77% in group 2, p = 0.84). In group 1 patients more frequently had myocardial infarction in the past (39% vs 8.3%, p = 0.025) and type 2 diabetes mellitus (35% vs 16%, p = 0.09). In patients with Syntax Score> 32 from the 1 group admission mean white blood cell count was 14700 ± 7800/μl, neutrophil count was 11750 ± 4800/μl. On 3-4 day leukocytosis increased up to 20720± 8800/ μl, neutrophil count to 18330 ± 8870/ μl, NLR reached 21.96 ± 17.33, that was significantly higher in comparison to the survivors with Syntax Score>32 (p<0.05). Higher monocytosis was associated with more severe coronary artery lesions. Patients with Syntax Score 23-32 from the 1 group had higher leukocytosis compared with such patients in group 2 (21170 ± 640/μl vs 15290 ± 1860/μl, p <0.01) due to neutrophilia (18280 ± 60/μl vs 11400 ± 180/μl, p <0.01). Patients with Syntax Score <23 in the 1 group had admission white blood cell count 15540 ± 4930/μl, in the 2 group - 11430 ± 4990/μl (p <0.05). On 3-4 day in patients with low Syntax Score from group 1 leucocytosis increased up to 17600 ± 8800/μl, neutrophil count reached 15320 ± 8870/μl, that was more significant than in those from the 2 group.
Among patients with MI complicated by cardiogenic shock females and patients with MI in the past had poor outcome more frequently. High neutrophil count and NLR in patients with cardiogenic shock is likely to be caused by more severe systemic inflammatory response and associated with poor prognosis in patients with MI and cardiogenic shock.