Clinical significance of neutrophil/limphocyte ratio and its associated risk in patients with acute coronary syndrome

Introduction: Inflammation plays an essential role in the development and complications associated with co-ronary artery disease.
Objective: The aim of this study was to evaluate the utility of the neutrophil/limphocyte ratio in assessing the mortality risk and complexity of coronary lesions in acute coronary syndromes.
Methods: A total of 81 patients were consecutively ad-mitted to the Coronary Intensive Care Unit of the Arad County Emergency Clinical Hospital with the primary diagnosis of Acute Coronary Syndrome (STEMI- Acu-te Myocardial Infarction, Non-STEMI Myocardial In-farction and Unstable Angina UA) between September 2015 – February 2016. For each patient, NLR ratio, the GRACE, TIMI and SYNTAX scores were calculated. For the statistical analysis, t student test was used for comparison of continuous variables with normal distribution, Wilcoxon test (Mann-Whitney) for continu-ous variables with asymmetric distribution, and Chi-Square test for comparison of categorical variables. In order to analyze the correlation between the variables, Pearson and Spearman coefficients were used.
Results: The mean age of the cohort was 60±8 years of which n=29 (35%) were women. The group was divi-ded into 3 groups: STEMI group n=19 (23%), NSTEMI group n=48 (59%) and UA group n=14 (17%). GRA-CE score was significantly higher among NSTEMI pa-tients (105.3±25.4) compared with those with STEMI [87.8±21.9], p=0.009), whereas the SYNTAX score was significantly higher among those with STEMI 11 (9 – 31) than those with NSTEMI [9 (5 – 13), p=0.002]. Leukocytes had significantly higher values among pa-tients with STEMI [11.2 (9.3-12.6)] than those with NSTEMI [9.4 (7.3-10.8)], (p=0.01), and AI [9 (6.4 -11.6)]. NLR ratio was higher among patients with STEMI [3.7 (2.3-5.8)], gradually decreasing in those with NSTEMI [3.2 (2.1-6.5)] and in those with UA [3 (1.4-3.7)]. NLR ratio correlated statistically significant with the GRACE score (p=0.03) and the ejection fracti-on (p=0.024). NLR did not correlate with the SYNTAX score (p=0.6) or TIMI score (p=0.4). Patients with bi-or trivascular coronary lesions showed a significantly higher NLR compared to patients with monovascular lesions (5.8±6 vs. 3.5±3, p=0.013).
Conclusions: Increased NLR ratio was seen among STEMI patients and statistically correlated with a hi-gher GRACE score and a lower ejection fraction. Also, patients with bi- or trivascular coronary lesions exhibi-ted a higher NLR ratio.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)