Korean Circ J.  2017 May;47(3):383-391. 10.4070/kcj.2016.0327.

Combined Use of Neutrophil to Lymphocyte Ratio and C-Reactive Protein Level to Predict Clinical Outcomes in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

• Shin HC
• Jang JS
• Jin HY
• Seo JS
• Yang TH
• Kim DK
• Kim DS

• KMID: 2385393
• DOI: http://doi.org/10.4070/kcj.2016.0327

Abstract

BACKGROUND AND OBJECTIVES
Both neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP) are biomarkers associated with poor prognosis of patients with acute myocardial infarction (AMI). However, the combined usefulness of NLR and CRP in predicting adverse outcomes has not been investigated.
SUBJECTS AND METHODS
We analyzed 381 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) from January 2012 to January 2014. The endpoints were all-cause mortality, recurrent myocardial infarction (MI), stent thrombosis, repeat revascularization, stroke, and major adverse cardiac and cerebrovascular events (MACCE) at 2-year follow-up. Included patients were divided into 4 groups according to the optimal cut-off values for NLR and CRP on receiver operating characteristic analysis predicting mortality.
RESULTS
Patients with both high NLR (>6.30) and high CRP (>0.76) had significantly greater risk of all-cause death and MACCE at 24 months, with no significant increase in the risk of recurrent MI, stent thrombosis, or stroke compared with patients with either low NLR or low CRP, as well as those with low NLR and low CRP. Kaplan-Meier analysis revealed significantly lower survival in patients with high NLR-CRP. On Cox multivariate analysis, high NLR-CRP (hazard ratio 23.172, 95% confidence interval 6.575 to 81.671, p<0.001) was an independent predictor of all-cause death.
CONCLUSION
Elevated levels of both NLR and CRP are associated with increased risk of long-term mortality in AMI patients who have undergone PCI.

Keyword

Neutrophils; Lymphocytes; Myocardial Infarction; Prognosis

MeSH Terms

Biomarkers
C-Reactive Protein*
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Lymphocytes*
Mortality
Multivariate Analysis
Myocardial Infarction*
Neutrophils*
Percutaneous Coronary Intervention*
Prognosis
ROC Curve
Stents
Stroke
Thrombosis
Biomarkers
C-Reactive Protein

Figure

• 

  Fig. 1 ROC curves of CRP and NLR according to 24 month all-cause death. CRP: C-reactive protein, NLR: neutrophil-to-lymphocyte ratio, AUC: area under the receiver operator characteristic curve, ROC: receiver operator characteristic, MACCE: major adverse cardiac and cerebrovascular events.

• 

  Fig. 2 Clinical outcomes in 4 groups at 24 months. Patients in the high NLR and high CRP group had significantly higher rates of all-cause mortality, cardiovascular mortality, and MACCE. The p values were compared between the low NLR-low CRP group and the high NLR-high CRP group. CV: cardiovascular, CRP: C-reactive protein, NLR: neutrophil-to-lymphocyte ratio, MACCE: major adverse cardiac and cerebrovascular events.

• 

  Fig. 3 Kaplan-Meier survival curve of 24 month all-cause death. Patients in the high NLR-high CRP group showed the lowest 24-month death-free survival of all groups. CRP: C-reactive protein, NLR: neutrophil-to-lymphocyte ratio.

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