Author + information
- Ramazan Can Öncel1,
- Mustafa Uçar1,
- Mustafa Serkan Karakaş2,
- Barış Akdemir3,
- Atakan Yanıkoğlu1,
- Ali Rıza Gülcan4,
- Refik Emre Altekin1 and
- İbrahim Demir1
Neutrophil/Lymphocyte ratio (NLR) is being increasingly used as a marker for cardiovascular risk assessment and as a prognostic tool in ST-elevated myocardial infarction (STEMI). In this study, we aimed to investigate the association of the NLR with GRACE risk score and in-hospital major advanced cardiac events in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
We analyzed 101 consecutive STEMI patents treated with primary PCI. Patients were divided into 3 groups by use of GRACE risk score. The NLR was calculated as a part of automated complete blood count. The association between NLR and GRACE risk score was assessed.
The study population consisted of 101 consecutive STEMI patients. 80.2% of patients were male and mean age of patients was 57.97±12.24 years. 42 patients were hypertensive,23 patients were diabetic,34 patients were hyperlipidemic and 57 were smoker.
According to the GRACE risk score,21 patients had low GRACE risk scores,48 patients had intermediate GRACE risk scores, 32 patients had high GRACE risk scores. Demographic and biochemical characteristics of patients in GRACE risk score groups are shown in table 1. The NLR showed a proportional increase correlated with GRACE risk score (p<0.001) (Table 1, Figure 1).
Correlation With In-Hospital Events
During the in-hospital period, 11 patients (10.9%) presented cardiac events (3 cardiac death, 2 reinfarction, 6 new-onset heart failure). These patients had more advanced Killip functional class and higher GRACE risk score. The occurrence of in hospital cardiac death, reinfarction or new-onset heart failure was significantly related to NLR at admission (8.18±1.16 vs. 3.07±1.77, p<0.001). Likewise, NLR and GRACE risk score showed a significant positive correlation (r=0.803, p<0.001) (Figure 2).
For in hospital cardiac events; N/L ratio,blood glucose level upon admission, troponin level at admission and in hospital GRACE death point were analyzed using a multivariate logistic regression model. The NLR was the only independent predictor of in-hospital cardiac events (odds ratio 3.63, confidence interval 95%: 1.31-10.04, p=0.013) (Table 2).
NLR has recently emerged as a potential new biomarker which singles out individuals at risk for future cardiovascular events in STEMI patients. Unlike many other inflammatory markers and bioassays, NLR is an inexpensive and readily available marker that provides an additional level of risk scores in predicting inhospital and long-term outcomes. Although the GRACE risk score is routinely used for stratification of patients with acute coronary syndrome, NLR may provide additional prognostic value. Increased NLR is independently associated with a higher rate of in-hospital cardiac events. The determination of NLR for risk stratification of STEMI patients during hospitalization may be useful.
|Men, n (%)||16 (76.2%)||43 (89.6%)||22 (68.8%)||0.063|
|HT, n (%)||9 (42.9%)||13 (21.7%)||20 (62.5%)||0.007|
|DM, n (%)||3 (14.3%)||11 (22.9%)||9 (28.1%)||0.501|
|HPL, n (%)||11 (52.4%)||13 (27.1%)||10 (31.3%)||0.116|
|Smoker, n (%)||15 (71.4%)||28 (58.3%)||14 (43.8%)||0.130|
Demographic and biochemical characteristics of patients in GRACE risk score groups (Abbreviations: BMI, body mass index; HT, hypertension; DM, diabetes mellitus; HPL, hyperlipidemia; WBC, white blood cell; NLR, neutrophil/lymphocyte ratio † p<0.001 compared with GRACE 108-140 points, ‡ p<0.001 compared with GRACE>140 points, * p<0.001 compared with GRACE<108 points, ** p=0.007 compared with GRACE<108 points, †† p=0.01 compared with GRACE<108 points)
|Variables||Odds ratio||CI 95%||P|
|İn hospital GRACE death point||1.03||0.98-1.07||0.2|
Multivariate logistic regression analyses in hospital cardiac events
Sunday, October 27, 2013, 14:00 PM–15:15 PM Hall: SARAJEVO
Abstract nos: 58-63