Yalcinkaya E, Yuksel UC, Celik M, Kabul HK, Barcin C, Gokoglan Y, Yildirim E, Iyisoy A. Relationship between neutrophil-to-lymphocyte ratio and electrocardiographic ischemia grade in STEMI.
Arq Bras Cardiol 2014;
104:112-9. [PMID:
25424159 PMCID:
PMC4375654 DOI:
10.5935/abc.20140179]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/25/2014] [Indexed: 11/21/2022] Open
Abstract
Background
Neutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future
adverse cardiovascular outcomes in patients with ST-segment elevation myocardial
infarction (STEMI). Changes in the QRS terminal portion have also been associated with
adverse outcomes following STEMI.
Objective
To investigate the relationship between ECG ischemia grade and NLR in patients
presenting with STEMI, in order to determine additional conventional risk factors for
early risk stratification.
Methods
Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG
performed on admission. White blood cells and subtypes were measured as part of the
automated complete blood count (CBC) analysis. Patients were classified into two groups
according to the ischemia grade presented on the admission ECG, as grade 2 ischemia
(G2I) and grade 3 ischemia (G3I).
Results
Patients with G3I had significantly lower mean left ventricular ejection fraction than
those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital
mortality rate increased proportionally with the increase in ischemia grade (p = 0.036).
There were significant differences in percentage of lymphocytes (p = 0.010) and
percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different
between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis
revealed that only NLR was the independent variable with a significant effect on ECG
ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120–1.403, p <
0.001).
Conclusion
We found an association between G3I and elevated NLR in patients with STEMI. We believe
that such an association might provide an additional prognostic value for risk
stratification in patients with STEMI when combined with standardized risk scores.
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