We investigated whether the neutrophil to lymphocyte ratio (NLR) can predict stent thrombosis (STh) and high mortality rate in patients with ST-segment elevation myocardial infarction (STEMI). We analyzed data of 102 patients with STh and 450 patients with STEMI admitted to 2 high volume hospitals. Preprocedural NLR was significantly higher in patients with STh (P < .001). There was a significantly higher mortality rate in patients with high NLR during hospitalization (P < .001). Also, in the STh group there was a significantly higher mortality rate in patients with high NLR (P < .001). In receiver–operating characteristic analysis, NLR >4.8 had 56% sensitivity and 68% specificity for predicting STh. The NLR >4.9 had 70% sensitivity and 65% specificity for predicting in-hospital mortality. On multivariate regression analysis, NLR was found to be significantly related to STh. In patients with STEMI, preprocedural high NLR is associated with both STh and higher mortality rates.
D’AscenzoFBollatiMClementiF. Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. Int J Cardiol. 2013;167(2):575–584.
2.
NiccoliGMontoneRAFerranteGCreaF. The evolving role of inflammatory biomarkers in risk assessment after stent implantation. J Am Coll Cardiol. 2010;56(22):1783–1793.
3.
ParkDWYunSCLeeJY. C-reactive protein and the risk of stent thrombosis and cardiovascular events after drug-eluting stent implantation. Circulation. 2009;120(20):1987–1995.
4.
SchoosMMKelbækHKofoedKF. Usefulness of preprocedure high-sensitivity C-reactive protein to predict death, recurrent myocardial infarction, and stent thrombosis according to stent type in patients with ST-segment elevation myocardial infarction randomized to bare metal or drug-eluting stenting during primary percutaneous coronary intervention. Am J Cardiol. 2011;107(11):1597–1603.
5.
ZahorecR. Ratio of neutrophil to lymphocyte counts – rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5–14.
6.
AçarGFidanSUsluZA. Relationship of neutrophil-lymphocyte ratio with the presence, severity, and extent of coronary atherosclerosis detected by coronary computed tomography angiography [published online February 19, 2014]. Angiology. 2014.
7.
AzabBChainaniVShahNMcGinnJT. Neutrophil-lymphocyte ratio as a predictor of major adverse cardiac events among diabetic population: a 4-year follow-up study. Angiology. 2013;64(6):456–465.
8.
ArbelYFinkelsteinAHalkinA. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis. 2012;225(2):456–460.
9.
AzabBZaherMWeiserbsKF. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol. 2010;106(4):470–476.
10.
ShenXHChenQShiYLiHW. Association of neutrophil/lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Chin Med J (Engl). 2010;123(23):3438–3443.
11.
CiçekGAçıkgozSKBozbayM. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio combination can predict prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology. 2015;66(5):441–447.
12.
SahinDYElbasanZGürM. Neutrophil to lymphocyte ratio is associated with the severity of coronary artery disease in patients with ST-segment elevation myocardial infarction. Angiology. 2013;64(6):423–429.
13.
DuffyBKGurmHSRajagopalVGuptaREllisSGBhattDL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol. 2006;97(7):993–996.
14.
AzabBShariffMABachirRNabagiezJPMcGinnJTJr. Elevated preoperative neutrophil/lymphocyte ratio as a predictor of increased long-term survival in minimal invasive coronary artery bypass surgery compared to sternotomy. J Cardiothorac Surg. 2013;8:193.doi: 10.1186/1749-8090-8-193.
15.
AkpekMKayaMGLamYY. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol. 2012;110(5):621–627.
16.
ChiaSNagurneyJTBrownDF. Association of leukocyte and neutrophil counts with infarct size, left ventricular function and outcomes after percutaneous coronary intervention for st-elevation myocardial infarction. Am J Cardiol. 2009;103(3):333–337.
17.
KayaAKayaYTopçuS. Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology. 2014;65(1):51–56.
18.
SibbingDBraunSJawanskyS. Assessment of ADP-induced platelet aggregation with light transmission aggregometry and multiple electrode platelet aggregometry before and after clopidogrel treatment. Thromb Haemost. 2008;99(1):121–126.
19.
HorneBDAndersonJLJohnJMWeaverABairTL. Inter mountain heart collaborative study group. which white blood cell subtypes predict increased cardiovascular risk?J Am Coll Cardiol. 2005;45(10):1638–1643.
20.
YarnellJWPattersonCCSweetnamPMLoweGD. Haemostatic/inflammatory markers predict 10-year risk of IHD at least as well as lipids: the Caerphilly collaborative studies. Eur Heart J. 2004;25(12):1049–1056.
21.
Meyer-SabellekWBraschH. Atherosclerosis, inflammation, leukocyte function and the effect of statins. J Hypertens. 2006;24(12):2349–2351.
22.
BianCWuYShiY. Predictive value of the relative lymphocyte count in coronary heart disease. Heart Vessels. 2010;25(6):469–473.
23.
GrauAJBoddyAWDukovicDABuggleFLichyCCAPRIE InvestigatorsLeukocyte count as an independent predictor of recurrent ischemic events. Stroke. 2004;35(5):1147–1152.
24.
CooperHAExnerDVWaclawiwMADomanskiMJ. White blood cell count and mortality in patients with ischemic and non- ischemic leftventricular systolic dysfunction (an analysis of the studies of left ventricular dysfunction [SOLVD]). Am J Cardiol. 1999;84(3):252–257.
25.
SparkJISarveswaranJBlestNCharalabidisPAsthanaS. An elevated neutrophil-lymphocyte ratio independently predicts mortality in chronic critical limb ischemia. J Vasc Surg. 2010;52(3):632–636.
26.
OttINeumannFJGawazMSchmittMSchömigA. Increased neutrophil-platelet adhesion in patients with unstable angina. Circulation. 1996;94(6):1239–1246.
27.
SiminiakTFloresNASheridanDJ. Neutrophil interactions with endothelium and platelets: possible role in the development of cardiovascular injury. Eur Heart J. 1995;16(2):160–170.
28.
OmmenSRGibbonsRJHodgeDOThomsonSP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol. 1997;79(6):812–814.
29.
NebekerJRVirmaniRBennettCL. Hypersensitivity cases associated with drug-eluting coronary stents: A review of available cases from the research on adverse drug events and reports (radar) project. J Am Coll Cardiol. 2006;47(1):175–181.
30.
VirmaniRGuagliumiGFarbA. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: Should we be cautious?Circulation. 2004;109(6):701–705.
31.
KotaniJAwataMNantoS. Incomplete neointimal coverage of sirolimus-eluting stents: Angioscopic findings. J Am Coll Cardiol. 2006; 47(10): 2108–2111.
32.
NakazawaGFinnAVJonerM. Delayed arterial healing and increased late stent thrombosis at culprit sites after drug eluting stent placement for acute myocardial infarction patients: An autopsy study. Circulation.2008;118(11): 1138–1145.
33.
FinnAVJonerMNakazawaG. Pathological correlates of late drug-eluting stent thrombosis: Strut coverage as a marker of endothelialization. Circulation.2007;115(18): 2435–2441.
34.
BisoendialRJKasteleinJJLevelsJH. Activation of inflammation and coagulation after infusion of C-reactive protein in humans. Circ Res. 2005;96(7):714–716.
35.
YudkinJSStehouwerCDEmeisJJCoppackSW. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue?Arterioscler Thromb Vasc Biol. 1999;19(4):972–978.
36.
TesfamariamBDeFeliceAF. Endothelial injury in the initiation and progression of vascular disorders. Vascul Pharmacol. 2007;46(4):229–237.
37.
SmitsPCHofmaSTogniM. Abluminal biodegradable polymer biolimus-eluting stent versus durable polymer everolimus-eluting stent (COMPARE II): a randomised, controlled, non-inferiority trial. Lancet. 2013;381(9867):651–660.
38.
MehilliJKastratiAWesselyR. Intracoronary stenting and angiographic restenosis--test equivalence between 2 drug-eluting stents (ISAR-TEST) trial investigators randomized trial of a nonpolymer-based rapamycin-eluting stent versus a polymer-based paclitaxel-eluting stent for the reduction of late lumen loss. Circulation. 2006;113(2):273–279.
39.
TamaiHIgakiKKyoE. Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans. Circulation. 2000;102(4):399–404.
40.
ErbelRDi MarioCBartunekJ. Temporary scaffolding of coronary arteries with bioabsorbable magnesium stents: a prospective, non-randomised multicentre trial PROGRESS-AMS (Clinical performance and angiographic results of coronary stenting with absorbable metal stents) investigators. Lancet. 2007;369(9576):1869–1875.
