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      Predictive value of neutrophil to lymphocyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis

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          Abstract

          Background

          The neutrophil to lymphocyte ratio (NLR) is an indicator of systemic inflammation and a prognostic marker in patients with acute coronary syndrome (ACS). This study aims to investigate the value of NLR to predict the in-hospital and long-term prognosis in patients with ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) by meta-analysis.

          Method

          The studies related to the prognosis of NLR and STEMI patients published in the Pubmed, Embase, and Ovid databases before June 2017 were retrieved. The relevant data were extracted. Review Manager Version 5.3 was used for meta-analysis.

          Results

          A total of 14 studies of 10,245 patients with STEMI after PCI were included. A significant difference was observed for mortality ( P < 0.001; relative risk (RR) 3.32; 95% confidence interval (CI) 2.45–4.49), hospital cardiac mortality( P < 0.001; RR 3.22; 95% CI 2.25–4.60), all mortality ( P < 0.001; RR 3.23; 95% CI 2.28–4.57), major adverse cardiovascular events (MACE) ( P < 0.001; RR 2.00; 95% CI 1.62–2.46), in-stent thrombosis ( P < 0.001; RR 2.72 95% CI 1.66–4.44), nonfatal myocardial infarction(MI) ( P < 0.001; RR 1.93; 95%CI 1.43–2.61), angina ( P = 0.007; RR 1.67; 95%CI 1.15–2.41), advanced heart failure (AHF) ( P < 0.001; RR 1.81; 95% CI 1.48–2.21), arrhythmia ( P = 0.002; RR 1.38; 95% CI 1.13–1.69), no reflow ( P < 0.001; RR 2.28; 95% CI 1.46–3.57), long-term all mortality ( P < 0.001; RR 3.82; 95% CI 2.94–4.96), cardiac mortality ( P = 0.004; RR 3.02; 95% CI 1.41–6.45), MACE ( P < 0.001; RR 2.49; 95% CI 1.47–4.23), and nonfatal MI ( P = 0.46; RR 1.32; 95% CI 0.63–2.75).

          Conclusions

          Meta-analysis shows that NLR is a predictor of hospitalization and long-term prognosis in patients with STEMI after PCI, but requires further confirmation by large randomized clinical trials.

          Electronic supplementary material

          The online version of this article (10.1186/s12872-018-0812-6) contains supplementary material, which is available to authorized users.

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          Most cited references30

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          Neutrophil to lymphocyte ratio and cardiovascular diseases: a review.

          Tariq Bhat, Sumaya Teli, Jharendra Rijal … (2013)
          The role of inflammatory markers in cardiovascular diseases has been studied extensively and a consistent relationship between various inflammatory markers and cardiovascular diseases has been established in the past. Neutrophil to lymphocyte ratio (NLR) is a new addition to the long list of these inflammatory markers. NLR, which is calculated from complete blood count with differential, is an inexpensive, easy to obtain, widely available marker of inflammation, which can aid in the risk stratification of patients with various cardiovascular diseases in addition to the traditionally used markers. It has been associated with arterial stiffness and high coronary calcium score, which are themselves significant markers of cardiovascular disease. NLR is reported as an independent predictor of outcome in stable coronary artery disease, as well as a predictor of short- and long-term mortality in patients with acute coronary syndromes. It is linked with increased risk of ventricular arrhythmias during percutaneous coronary intervention (PCI) and higher long-term mortality in patients undergoing PCI irrespective of indications of PCI. In patients admitted with advanced heart failure, high NLR was reported with higher inpatient mortality. Recently, NLR has been reported as a prognostic marker for outcome from coronary artery bypass grafting and postcoronary artery bypass grafting atrial fibrillation.
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            Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction.

            Julio Núñez, Eduardo Núñez, Vicent Bodí … (2008)
            Neutrophil to lymphocyte ratio (N/L) has been associated with poor outcomes in patients who underwent cardiac angiography. Nevertheless, its role for risk stratification in acute coronary syndromes, specifically in patients with ST-segment elevation myocardial infarction (STEMI), has not been elucidated. We sought to determine the association of N/L maximum value (N/L max) with mortality in the setting of STEMI and to compare its predictive ability with total white blood cell maximum count (WBC max). We analyzed 515 consecutive patients admitted with STEMI to a single university center. White blood cells (WBC) and differential count were measured at admission and daily for the first 96 hours afterward. Patients with cancer, inflammatory diseases, or premature death were excluded, and 470 patients were included in the final analysis. The association between N/L max and WBC max with mortality was assessed by Cox regression analysis. During follow-up, we registered 106 deaths (22.6%). A positive trend between mortality and N/L max quintiles was observed; 6.4%, 12.4%, 11.7%, 34%, and 47.9% of deaths occurred from quintiles 1 to 5 (p <0.001), respectively. In a multivariable setting, after adjusting for standard risk factors, patients in the fourth (Q4 vs Q1) and fifth quintile (Q5 vs Q1) showed the highest mortality risk (hazard ratio 2.58, 95% confidence interal 1.06 to 6.32, p = 0.038 and hazard ratio 4.20, 95% confidence interal 1.73 to 10.21, p = 0.001, respectively). When WBC max and cells subtypes were entered together, N/L max remained as the only WBC parameter; furthermore, the model with N/L max showed the most discriminative ability. In conclusion, N/L max is a useful marker to predict subsequent mortality in patients admitted for STEMI, with a superior discriminative ability than total WBC max.
            Article 0 comments Cited 139 times – based on 0 reviews     Review now
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              Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography.

              Yaron Arbel, Ariel Finkelstein, Amir Halkin … (2012)
              White blood cell count is an independent predictor of cardiovascular events and mortality. Neutrophil/lymphocyte ratio (NLR) is a biomarker that can single out individuals at risk for vascular events. To evaluate whether NLR adds additional information beyond that provided by conventional risk factors and biomarkers for coronary artery disease (CAD) severity and adverse outcome, in a large cohort of consecutive patients referred for coronary angiography. NLR was computed from the absolute values of neutrophils and lymphocytes from the complete blood count of 3005 consecutive patients undergoing coronary angiography for various indications. CAD severity was determined by an interventional cardiologist unaware of the study aims. The association between NLR and CAD severity was assessed by logistic regression and the association between NLR and 3-years outcome were analyzed using Cox regression models, adjusting for potential clinical, metabolic, and inflammatory confounders. The cohort was divided into 3 groups according to the NLR value ( 3). NLR was independently associated with CAD severity and it contributed significantly to the regression models. Patients with NLR >3 had more advanced obstructive CAD (OR = 2.45, CI 95% 1.76-3.42, p < 0.001) and worse prognosis, with a higher rate of major CVD events during up to 3 years of follow-up (HR = 1.55, CI 95% 1.09-2.2, p = 0.01). Neutrophil/lymphocyte ratio is independently associated with CAD severity and 3-years outcome. NLR value appears additive to conventional risk factors and commonly used biomarkers. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
              Article 0 comments Cited 118 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Sai Zhang: zhangsaijs@163.com
                Jun Diao: 1297403115@qq.com
                Chunmei Qi: 1242436142@qq.com
                Jingjing Jin: 1216603463@qq.com
                Li Li: lilyrwyao@126.com
                Xingjuan Gao: 1172944436@qq.com
                Lei Gong: lg2707@qq.com
                Weiheng Wu:
                ORCID: http://orcid.org/0000-0002-3123-7807
                wwheng118@163.com
                Journal
                Journal ID (nlm-ta): BMC Cardiovasc Disord
                Journal ID (iso-abbrev): BMC Cardiovasc Disord
                Title: BMC Cardiovascular Disorders
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2261
                Publication date (Electronic): 2 May 2018
                Publication date PMC-release: 2 May 2018
                Publication date Collection: 2018
                Volume: 18
                Electronic Location Identifier: 75
                Affiliations
                [1 ]GRID grid.413389.4, Department of Cardiology, , The Second Affiliated Hospital of Xuzhou Medical University, ; Xuzhou, Jiangsu China
                [2 ]GRID grid.413389.4, The Second Affiliated Hospital of Xuzhou Medical University, ; 32th Meijian Road, 221000 Xuzhou, Jiangsu People’s Republic of China
                Author information
                http://orcid.org/0000-0002-3123-7807
                Article
                Publisher ID: 812
                DOI: 10.1186/s12872-018-0812-6
                PMC ID: 5930503
                PubMed ID: 29716535
                SO-VID: e7f434a8-c620-4e6d-b8d3-45b132415d00
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 25 November 2017
                Date accepted : 20 April 2018
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: neutrophil to lymphocyte ratio,st segment elevation myocardial infarction,percutaneous coronary intervention,inflammation,mortality,prognosis
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: neutrophil to lymphocyte ratio, st segment elevation myocardial infarction, percutaneous coronary intervention, inflammation, mortality, prognosis

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