Abstract
Objective: To determine the frequency of in-hospital mortality in patients with high NLR presenting with STEMI. Methodology: Consecutive patients with STEMI and high NLR presenting at Cardiology department, Lady Reading Hospital, Peshawar were evaluated for our study. Out of the 236 patients admitted from 1st September 2015 to 28th February 2016, 191 patients qualified for study inclusion. NLR was calculated by dividing the total number of neutrophils over the total number of lymphocytes obtained via a computerized heamogram. A high NLR was defined as value >4.7. In hospital mortality and the effect of various class of patients with or without conventional risk factors was assessed. Results: The mean high NLR in study population was 6.38±1.28. In-hospital mortality due to cardiac cause was 12% (n=23) which included 8.37% (n=16) males. Statistically significant higher values of mean high NLR were found to be associated with in-hospital mortality and presence of conventional risk factors including hypertension, diabetes, and smoking with the exception of hypercholesterolemia. Among the patients who died, more had adverse events in form of higher Killip class and arrythmias. Conclusion: High NLR has fair prognostic value in patients presenting with acute STEMI. Raised values correlate well with the presence of conventional risk factors which increase the risk of post MI adverse events and appears additive to conventional risk factors and biomarkers. Key Words: ST elevation myocardial infarction (STEMI), Neutrophil to lymphocyte ratio (NLR), Total leucocyte count (TLC), Coronary artery disease (CAD), Acute coronary syndrome (ACS)
Highlights
Cardiovascular disease (CVD) has become an important cause of mortality in most countries.[1]
Significant higher values of mean high Neutrophil to lymphocyte ratio (NLR) were found to be associated with in-hospital mortality and presence of conventional risk factors including hypertension, diabetes, and smoking with the exception of hypercholesterolemia
High NLR has fair prognostic value in patients presenting with acute ST elevation myocardial infarction (STEMI)
Summary
Cardiovascular disease (CVD) has become an important cause of mortality in most countries.[1]. Leukocytes play a crucial role in the progression of atherosclerosis leading to CAD.[4] An association between increased WBC count, severity of CAD and survival has been described in patients with acute coronary syndrome (ACS).[5] Neutrophils are the most abundant leukocytes in the peripheral blood. After onset of ischemia, endothelial cells release adhesion molecules that, along with released chemokines, trigger neutrophil release.[6] Increased neutrophil count in peripheral blood is associated with short-term post-MI adverse outcomes and worse angiographic findings.[7] Higher values of leukocyte subtypes and NLR, in patients with ACS, has been associated with adverse clinical outcome and procedural results after percutaneous coronary intervention (PCI).[8, 9] NLR has a high value in predicting death and/or MI in high risk patients with CAD.[10]
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