The Neutrophil Lymphocyte Ratio (NLR); recycled as Predictor of Angiographic Coronary Artery Disease Severity in stable Ischaemic Heart Disease

Abstract

Background: The Neutrophil lymphocyte ratio (NLR) is historically well established in predicting inflammatory process and severity, including atherosclerotic disease. We explore the NLR and how it relates to angiographic coronary artery disease (CAD) severity in patients with stable ischemic heart disease (SIHD). Materials and Methods: We identified 714 patients with SIHD from the local database of Benghazi Medical Centre (BMC) between Jan 2019-June 2020. Exclusion criteria included patients with acute coronary syndromes (ACS), surgical revascularization, moderate-severe left ventricle systolic dysfunction (LVSD) with Ejection fraction less than 45% or New York Heart Association (NYHA) class III-IV. We also excluded patients with significant co-morbidities including chronic kidney disease with glomerular filtration rate (GFR <30), liver cirrhosis, cancer and systemic inflammation requiring long-term steroid therapy. We present a retrospective, cross-sectional study of 427 patients with known SIHD, we explored the relationship between the NLR and the angiographic severity of CAD, using the Gensini score (GS). The association was assessed using correlation analysis and bivariate logistical regression. Results: Patients were categorized into two groups according to the GS, a mild-moderate group (n=178; 41.7%) and a severe group (n=249; 58.3%). A baseline NLR was measured by dividing the Neutrophil count over the Lymphocyte count. In the first group of mild-moderate GS, 160 (89.9%) had an NLR within normal range and 18 (10.1%) demonstrated a high NLR value. However, in the severe GS group 17 (6.8%) showed a normal NLR and 232 (93.2%) demonstrated a high NLR (CI 95%, p=0.0001). Moreover, the distribution of severe GS CAD had a statistically significant overlap with diabetes being the number one risk factor (p=0.0001) when compared to age above 50 (p=0.024). Conclusion: NLR is a valuable independent predictor of the severity of CAD and seems to be a reliable indicator for cardiac risk stratification in patients with SIHD, therefore can potentially be added as a prioritization tool for cardiac angiography.