J Korean Med Sci.  2021 May;36(19):e131. 10.3346/jkms.2021.36.e131.

Neutrophil-to-Lymphocyte Ratio at Emergency Room Predicts Mechanical Complications of ST-segment Elevation Myocardial Infarction

• Yoon GS
• Choi SH
• Woo SI
• Baek YS
• Park SD
• Shin SH
• Kim DH
• Kwan J
• Lee MJ
• Kwon SW

• KMID: 2515866
• DOI: http://doi.org/10.3346/jkms.2021.36.e131

Abstract

Background
The neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI).
Methods
A total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization.
Results
Patients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P= 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001).
Conclusion
NLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.

Keyword

Neutrophil-to-Lymphocyte Ratio; Mechanical Complications of STEMI; Prognosis

Figure

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  Fig. 1 Flowchart of the study population.STEMI = ST-elevation myocardial infarction, PCI = percutaneous coronary intervention, NLR = neutrophil-to-lymphocyte ratio.

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  Fig. 2 Mechanical complication rate (A) and mortality rate (B) during hospitalization according to NLR tertiles.NLR = neutrophil-to-lymphocyte ratio.

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