Predictive value of neutrophil to lymphocyte ratio in long‐term outcomes of left main and/or three‐vessel disease in patients with acute myocardial infarction

Abstract

We sought to evaluate the independent predictive value of left main disease (LMD) and/or three-vessel disease (LMD/3VD) in acute myocardial infarction (AMI) patients. Patients with acute coronary syndrome resulting from LMD and/or three-vessel disease (LMD/3VD) are at the highest risk of adverse cardiovascular events. Neutrophil to lymphocyte ratio (NLR) has been proposed as a marker of cardiovascular risk, but the prognostic value of NLR in patients with LMD/3VD who underwent percutaneous coronary intervention (PCI) is not clearly defined. Patients (n = 806) admitted with LMD/3VD who underwent PCI between January 2013 and December 2013 were followed up for 2 years. Admission NLR was divided into two sub-groups based on an optimal cut off value predicting 2-year all-cause mortality. The primary end point was all-cause death. The secondary end point was long-term major adverse cardiovascular and cerebrovascular events (MACCE). During follow-up, the high NLR group was associated with a significantly higher rate of long-term all-cause mortality (6.7 vs. 0.9%, P < .001), and MACCE (24.7 vs. 15.8%, P = .002) compared to the low NLR group. In multivariate analysis, after adjusting for risk factors, NLR ≥ 3.39 was determined to be an independent predictor of 2-year all-cause mortality (hazard ratio[HR] 3.08, 95% confidence interval [CI] 1.06 to 8.97, P = .039) and MACCE (hazard ratio 1.44, 95% CI 1.01 to 2.05, P = .046) for LMD/3VD. The admission NLR as relatively inexpensive marker of inflammation may aid in the risk stratification and prognosis of patients diagnosed with LMD/3VD.