Abstract
Background: In myocardial infarction (MI) patients, myocardial reperfusion and subsequently, early infarct related artery (IRA) patency are very critical in this emergency situation. Recently, there is growing research on the ability of platelet to lymphocyte ratio (PLR) to be a predictor of outcome and its value as a marker for inflammation and coagulopathy detection. Our work aims at finding the relation between PLR and the prognosis of IRA in STEMI patients. Methodology: Two hundred cases presented with STEMI were included for the study. Patency of IRA was estimated by Thrombolysis in Myocardial Infarction (TIMI) grade. Patent IRA was defined as TIMI grade III flow and occluded IRA was defined as TIMI grade 0-II flow. Blood samples were withdrawn on admission at emergency department to calculate PLR. Results: Forty-one (20.5%) cases revealed TIMI 3 flow in IRA before pPCI. Occluded group showed significantly higher PLR than patent group with mean PLR 231.3±94.2 vs 100.95±37.7 respectively with P value <0.0001. Multivariate regression analysis demonstrated, both HTN [95% CI (- 0.135)-(-0.747)] & PLR ratio [95% CI (-0.001)-(-0.002)] together are the most independent predictors for TIMI flow in IRA (F-ratio=12.2, p<0.001). Conclusion: our results show that high Platelet lymphocyte ratio predicts patency of IRA independently in cases with STEMI before pPCI.
Highlights
To achieve infarct related artery (IRA) patency, Primary percutaneous coronary intervention is a standard of care and it is urged to be done as early as possible to prevent myocardial infarction (MI) and improve outcomes [3], It has been agreed that the prognosis and cardiac muscle recovery in segment elevation myocardial infarction (STEMI) cases after pPCI is affected by the IRA patency before pPCI [4]
Our study was similar to the previous mentioned study in that we found that left ventricular ejection fraction (LVEF) was significantly lower in occluded group than patent group [47.8%±10.3% vs 58.4%±6.9% respectively,(p value
In the current study we demonstrated that PLR is an important predictor of patency of IRA in cases presented with STEMI before pPCI, PLR was predominantly elevated in occluded IRA
Summary
The pathological process of coronary atherosclerosis leads eventually to thrombosis and occlusion of coronary arteries resulting in cardiac muscle ischemia and can be sever to level of muscle tissue ischemic necrosis or what is called myocardial infarction (MI) and in acute early cases it lead to electrocardiography heart changes and is termed ST-segment elevation myocardial infarction (STEMI) [1, 2]To achieve IRA patency, Primary percutaneous coronary intervention (pPCI) is a standard of care and it is urged to be done as early as possible to prevent MI and improve outcomes [3], It has been agreed that the prognosis and cardiac muscle recovery in STEMI cases after pPCI is affected by the IRA patency before pPCI [4].The Inflammatory process plays a pivotal role in atherosclerosis formation and its establishment [5, 6]. Total leucocyte count (TLC) has been studied as a marker for inflammation and whether it has a prognostic value in coronary artery atherosclerosis [7, 8]. PLR has been studied in cases with advanced coronary disease reflected in the higher Syntax scores and no-reflow phenomenon and it was found that PLR is an independent risk factor, [13] the research about the prognostic significance of IRA patency before pPCI in Abdalla Mostafa Kamal et al.: Platelet to Lymphocyte Ratio as a Predictor of Infarct-Related Artery. There is growing research on the ability of platelet to lymphocyte ratio (PLR) to be a predictor of outcome and its value as a marker for inflammation and coagulopathy detection. Conclusion: our results show that high Platelet lymphocyte ratio predicts patency of IRA independently in cases with STEMI before pPCI
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