Korean Circ J.  2013 Feb;43(2):93-99. 10.4070/kcj.2013.43.2.93.

Neutrophil to Lymphocyte Ratio Predicts Long-Term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

• Han YC
• Yang TH
• Kim DI
• Jin HY
• Chung SR
• Seo JS
• Jang JS
• Kim DK
• Kim DK
• Kim KH
• Seol SH
• Kim DS

• KMID: 1769644
• DOI: http://doi.org/10.4070/kcj.2013.43.2.93

Abstract

BACKGROUND AND OBJECTIVES
A higher neutrophil to lymphocyte ratio (NLR) has been associated with poor clinical outcomes in various cardiac diseases. However, the clinical availability of NLR in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been known. We evaluated the availability of NLR to predict clinical outcomes in patients with STEMI undergoing primary PCI.
SUBJECTS AND METHODS
We analyzed 326 consecutive STEMI patients treated with primary PCI. The patients were divided into tertiles according to NLR: NLR< or =3.30 (n=108), 3.316.53 (n=110). We evaluated the incidence of major adverse cardiac events (MACE), a composite of all causes of death, non-fatal MI, and ischemic stroke at the 12-month follow-up.
RESULTS
The high NLR group was associated with a significantly higher rate of 12-month MACE (19.1% vs. 3.7%, p<0.001), 12-month death (18.2% vs. 2.8%, p<0.001), in-hospital MACE (12.7% vs. 2.8%, p=0.010) and in-hospital death (12.7% vs. 1.9%, p=0.003) compared to the low NLR group. In the multivariable model, high NLR was an independent predictor of 12-month MACE {hazard ratio (HR) 3.33 (1.09-10.16), p=0.035} and death {HR 4.10 (1.17-14.46), p=0.028} after adjustment for gender, left ventricular ejection fraction, creatinine clearance, angiographic parameters and factors included in the Thrombolysis in Myocardial Infarction risk score for STEMI. There was a significant gradient of 12-month MACE across the NLR tertiles with a markedly increased MACE hazard in the high NLR group (log rank test p=0.002).
CONCLUSION
The NLR is a useful marker to predict 12-month MACE and death in patients with STEMI who have undergone primary PCI.

Keyword

Neutrophils; Lymphocytes; Myocardial infarction

MeSH Terms

Cause of Death
Creatinine
Heart Diseases
Humans
Incidence
Lymphocytes
Myocardial Infarction
Neutrophils
Percutaneous Coronary Intervention
Stroke
Stroke Volume
Creatinine

Figure

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  Fig. 1 Study flow diagram. CABG: coronary artery bypass graft, BMS: bare metal stent, WBC: white blood cell.

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  Fig. 2 Major adverse cardiovascular events (MACE) free survival curves according to the tertiles of neutrophil to lymphocyte ratio.

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  Fig. 3 Major adverse cardiovascular events (MACE) at 12-months stratified by neutrophil to lymphocyte ratio and Thrombolysis in Myocardial Infarction (TIMI) risk score.

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