Author + information
- Guilherme Pinheiro Machado1,
- Gustavo Neves de Araújo2,
- Felipe Homem Valle3,
- Mateus Lech4,
- Stéfani Mariani5,
- Christian Carpes6,
- Felipe Marques7,
- Luiz Carlos Bergoli8,
- Sandro Cadaval Gonçalves2,
- Fernando Pivatto Júnior2,
- Ana Maria Krepsky2,
- Rodrigo Wainstein7 and
- Marco Wainstein7
- 1Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- 2Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- 3Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Norte, Brazil
- 4Federal University of Rio Grande do Sul, Canoas, Rio Grande do Sul, Brazil
- 5Universidade Federal do Rio Grande do Sul, Estrela, Rio Grande do Sul, Brazil
- 6Universidade Federal do Rio Grande do Sul, PORTO ALEGRE, Rio Grande do Sul, Brazil
- 7Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- 8Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
Elevated neutrophil-to-lymphocyte ratio (NLR) during ST-segment elevation myocardial infarction (STEMI) is associated with adverse clinical outcomes at short and long term follow up. The aim of the present study was to investigate the usefulness of NLR predict adverse events in patients with STEMI submitted to primary percutaneous coronary interventions (pPCI) in a tertiary University Hospital in southern Brazil.
We have included 524 consecutive patients with STEMI submitted to pPCI between April/2011 and February/2017. The baseline NLR values from consecutive patients undergoing PCI were screened. Patients were divided into two groups, low and high NLR. A high value of NLR was defined as above 75º percentile (>9.45). It was evaluated the occurrence of contrast-induced nephropathy, complications during the procedure and major adverse cardiac and cerebrovascular events (MACCE) in-hospital and short-term (30 days).
Mean age was 60.41(±12.01), 64.8% were male, 63.6% had hypertension 24.8% had diabetes and NLR median was 6.1. Patients who suffered any in-hospital MACCE or complications during pPCI had a higher NLR value with a significant difference in the comparison of medians (5.83 vs 7.44; p=0.03 and 5.81 vs 7.97; p=0.01). Patients with higher values of NLR had significantly greater risk of complications during procedure (p<0.001) [OR 2.49 CI95% 1.47-4.21], in-hospital MACCE (p<0.01) [OR 2.07 CI 1.19-3.6] and total MACCE p<0.02 [OR 1.61 CI95% 1.04-2.51 without significant increase in the risk CIN and short-term MACCE. When analyzed individually, only no-reflow (p<0.03 [OR 2.19 CI95% 1.05-4.6] and distal embolization (p<0.001) [OR 4.47 CI95% 1.75-11.4] were statistically different. In multivariate analysis, when adjusted for sex, LVEF<40%, Diabetes, Smoking, POCD and Creatinin, NLR remained independent predictors of in-hospital MACCE(p=0.04)(Table 1). The area under the ROC curve for in-hospital MACCE was 0.609 for NLR (p = 0.03) [CI95% 0.54-0.63]. An NLR score cutoff point of >6.04 yielded a sensitivity of 66.7% and specificity of 51.9% Low-risk score had an excellent negative predictive value of 91.6% (87.6 - 94.7), while high-risk score had a positive predictive value of 16.4% (12.1 - 21.4).
|Mutivariate Analysis||n(%)||OR (CI-95%)||p-value|
|Distal Embolization||20 (4.2)||3.69 (1.39-9.87)||0.009|
|No-reflow||31 (6.1)||1.93 (0.86-4.24)||0.10|
|Complications during pPCI||78 (15.1)||2.13 (1.20-3.73)||0.01|
|MACCE - in-hospital||69 (13.2)||1.06 (1.02 - 1.73)||0.04|
|MACCE - Total||136 (26.4)||1.03 (0.99 - 1.07)||0.06|
A high NLR value is an independent predictor of adverse outcomes in patients with STEMI submitted to pPCI, especially during in-hospital period. Although, a low NLR value has an excellent negative predictive value for adverse outcomes. Because it's a quick, simple, low-cost tool, it may have a great applicability at bedside.
CORONARY: PCI Outcomes