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Murakami T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Hatori M, Tamanaha Y, Kasahara T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Development of a simple prediction model for mechanical complication in ST-segment elevation myocardial infarction patients after primary percutaneous coronary intervention. Heart Vessels 2024; 39:288-298. [PMID: 38008806 DOI: 10.1007/s00380-023-02336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/01/2023] [Indexed: 11/28/2023]
Abstract
Mechanical complication (MC) is a rare but serious complication in patients with ST-segment elevation myocardial infarction (STEMI). Although several risk factors for MC have been reported, a prediction model for MC has not been established. This study aimed to develop a simple prediction model for MC after STEMI. We included 1717 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). Of 1717 patients, 45 MCs occurred after primary PCI. Prespecified predictors were determined to develop a tentative prediction model for MC using multivariable regression analysis. Then, a simple prediction model for MC was generated. Age ≥ 70, Killip class ≥ 2, white blood cell ≥ 10,000/µl, and onset-to-visit time ≥ 8 h were included in a simple prediction model as "point 1" risk score, whereas initial thrombolysis in myocardial infarction (TIMI) flow grade ≤ 1 and final TIMI flow grade ≤ 2 were included as "point 2" risk score. The simple prediction model for MC showed good discrimination with the optimism-corrected area under the receiver-operating characteristic curve of 0.850 (95% CI: 0.798-0.902). The predicted probability for MC was 0-2% in patients with 0-4 points of risk score, whereas that was 6-50% in patients with 5-8 points. In conclusion, we developed a simple prediction model for MC. We may be able to predict the probability for MC by this simple prediction model.
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Affiliation(s)
- Tsukasa Murakami
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Masashi Hatori
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Yusuke Tamanaha
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Taku Kasahara
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama, 330-8503, Japan
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Gao T, Yu X. Association between nutritional status scores and the 30-day mortality in patients with acute kidney injury: an analysis of MIMIC-III database. BMC Nephrol 2023; 24:296. [PMID: 37803270 PMCID: PMC10559585 DOI: 10.1186/s12882-023-03329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/10/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Studies have proven that the risk of acute kidney injury (AKI) increased in patients with malnutrition. Prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) were general tools to predict the risk of mortality, but the prognostic value of them for in-hospital mortality among patients with AKI have not been validated yet. Herein, this study aims to explore the association between PNI and GNRI and 30-day mortality in patients with AKI. METHODS Demographic and clinical data of 863 adult patients with AKI were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database in 2001-2012 in this retrospective cohort study. Univariate and multivariate Cox proportional regression analyses were used to explore the association between PNI and GNRI and 30-day mortality. The evaluation indexes were hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses of age, Sequential Organ Failure Assessment (SOFA) score and Simplified Acute Physiology (SAPS-II) score were also performed. RESULTS Totally, 222 (26.71%) patients died within 30 days. After adjusting for covariates, PNI ≥ 28.5 [HR = 0.71, 95%CI: (0.51-0.98)] and GNRI ≥ 83.25 [HR = 0.63, 95%CI: (0.47-0.86)] were both associated with low risk of 30-day mortality. These relationships were also found in patients who aged ≥ 65 years old. Differently, high PNI level was associated with low risk of 30-day mortality among patients with SOFA score < 6 or SAPS-II score < 43, while high GNRI was associated with low risk of 30-day mortality among those who with SOFA score ≥ 6 or SAPS-II score ≥ 43 (all P < 0.05). CONCLUSION PNI and GNRI may be potential predictors of 30-day mortality in patients with AKI. Whether the PNI is more recommended for patients with mild AKI, while GNRI for those with severe AKI is needed further exploration.
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Affiliation(s)
- Tingting Gao
- Department of Comprehensive Medical, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, P.R. China
| | - Xueyuan Yu
- Department of Nephrology, Qi Lu Hospital of Shandong University, No.107 Wenhua west road, Lixia District, Jinan, 250012, Shandong, P.R. China.
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Huang Y, Zhang Q, Li P, Chen M, Wang R, Hu J, Chi J, Cai H, Wu N, Xu L. The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction. BMC Cardiovasc Disord 2023; 23:339. [PMID: 37403066 DOI: 10.1186/s12872-023-03350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Malnutrition is common in patients with acute myocardial infarction (AMI) and is associated with a poor prognosis. The prognostic value of the prognostic nutritional index (PNI) in patients with AMI remains controversial. We aimed to explore the relationship between PNI and all-cause mortality in critically ill patients with AMI and evaluate the incremental prognostic value of PNI to commonly used prognostic assessment tools. METHODS The Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was used to conduct a retrospective cohort analysis on 1180 critically ill patients with AMI. The primary endpoints were defined as 6-month and 1-year all-cause mortality. Cox regression analysis was used to investigate the relationship between admission PNI and all-cause mortality. The effect of adding PNI to sequential organ failure assessment (SOFA) score, or charlson comorbidity index (CCI) on its discriminative ability was assessed using C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS Multivariate cox regression analysis demonstrated that the low PNI was regarded as an independent predictor of 1-year all-cause mortality in AMI patients admitted to ICU (adjusted Hazard Ratio: 95% CI = 1.75 (1.22-2.49)). The ROC test showed that admission PNI had a moderate predictive ability to predict all-cause mortality of critically ill patients with AMI. Furthermore, the net reclassification and integrated discrimination of the CCI alone model improved significantly with PNI. [C-statistic increased from 0.669 to 0.752, p < 0.001; NRI = 0.698, p < 0.001; IDI = 0.073, p < 0.001]. When PNI was added to the SOFA score, the C-statistic significantly improved from 0.770 to 0.805 (p < 0.001), and the NRI and IDI were estimated at 0.573 (p < 0.001) and 0.041 (p < 0.001), respectively. CONCLUSION PNI could be a novel predictor for identifying patients at high risk of 1-year all-cause mortality in critically ill patients with AMI. The addition of PNI to the SOFA score or CCI may be useful for very early risk stratification.
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Affiliation(s)
- Yuekang Huang
- Department of Geriatric Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, 510000, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, 510000, China
| | - Qunhui Zhang
- Department of Cardiology, The First Affiliated Hospital, University of South China, Hengyang, 421001, China
| | - Pengfei Li
- Department of Geriatric Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, 510000, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, 510000, China
| | - Meixiang Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China
| | - Ruixin Wang
- Department of Geriatric Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, 510000, China
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, 510000, China
| | - Jiaman Hu
- Department of Geriatric Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, 510000, China
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, 510000, China
| | - Jianing Chi
- Department of Geriatric Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, 510000, China
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, 510000, China
| | - Hua Cai
- Department of Geriatric Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, 510000, China
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, 510000, China
| | - Ningxia Wu
- Department of Geriatric Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, 510000, China
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, 510000, China
| | - Lin Xu
- Department of Geriatric Cardiology, General Hospital of the Southern Theatre Command, Guangzhou, 510000, China.
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China.
- Branch of National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Guangzhou, 510000, China.
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Han K, Shi D, Yang L, Wang Z, Li Y, Gao F, Liu Y, Ma X, Zhou Y. Prognostic value of systemic inflammatory response index in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Ann Med 2022; 54:1667-1677. [PMID: 35695557 PMCID: PMC9225721 DOI: 10.1080/07853890.2022.2083671] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The systemic inflammatory response index (SIRI) is a novel inflammatory biomarker in many diseases. OBJECTIVES The aim of this study was to examine the association between SIRI and adverse events in patients with the acute coronary syndrome (ACS) undergoing percutaneous coronary intervention. METHODS A total of 1724 patients with ACS enrolled from June 2016 to November 2017 at a single centre were included in this study, and SIRI was calculated for each patient. The primary endpoint was the composite of major adverse cardiovascular events (MACE), including overall death, non-fatal myocardial infarction, non-fatal stroke, and unplanned repeat revascularization. RESULTS During a median follow-up of 927 days, 355 patients had MACE. Multivariate Cox analysis showed that SIRI was significantly associated with MACE (hazard ratio: 1.127, 95% confidence interval: 1.034-1.229 p = .007). The results were consistent in multiple sensitivity analyses. The addition of SIRI had an incremental effect on the predictive ability of the Global Registry of Acute Coronary Events risk score for MACE (integrated discrimination improvement: 0.007, p = .040; net reclassification improvement: 0.175, p = .020; likelihood ratio test: p < .001). The restricted cubic spline showed a monotonic increase with a greater SIRI value for MACE (p < .001). CONCLUSION SIRI was an independent risk factor for MACE and provided incremental prognostic information in patients with ACS undergoing percutaneous coronary intervention. KEY MESSAGESThe SIRI is a strong and independent risk factor for adverse outcomes in patients with ACS undergoing percutaneous coronary intervention.Higher SIRI is associated with a more severe disease status.The SIRI could increase the prognostic value of the GRACE risk score.
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Affiliation(s)
- Kangning Han
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Dongmei Shi
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Lixia Yang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Zhijian Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yueping Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Fei Gao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yuyang Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Xiaoteng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yujie Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
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Predictive Value of Lymphocyte-to-monocyte Ratio in Patients with Contrast-induced Nephropathy After Percutaneous Coronary Intervention for Acute Coronary Syndrome. J Transl Int Med 2021; 9:123-130. [PMID: 34497751 PMCID: PMC8386327 DOI: 10.2478/jtim-2021-0024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives Lymphocyte-to-monocyte ratio (LMR) has emerged as a new indirect marker of inflammation, which is associated with adverse outcomes in cardiovascular diseases. The aim of this study was to evaluate whether admission LMR is associated with contrast-induced nephropathy (CIN) in patients who underwent percutaneous coronary intervention for acute coronary syndrome (ACS). Methods A total of 873 patients were assessed. LMR was calculated via dividing lymphocyte count by monocyte count. Results LMR was significantly lower in the with-CIN group. ROC analysis showed that the LMR ratios <2.52 predicted CIN development with sensitivity of 66.3% and specificity of 55.8%. Multivariate analysis showed that eGFR, admission glucose, and LMR were independent predictors of CIN in patients with ACS. Conclusion LMR is an easily accessible marker and could be used as a predictor of CIN in patients with ACS undergoing percutaneous coronary intervention.
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Kurtul A, Gok M, Esenboga K. Prognostic Nutritional Index Predicts Contrast-Associated Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction. ACTA CARDIOLOGICA SINICA 2021; 37:496-503. [PMID: 34584382 DOI: 10.6515/acs.202109_37(5).20210413a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Contrast-associated acute kidney injury (CA-AKI) previously known as contrast-induced nephropathy is associated with a worse prognosis in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). The prognostic nutritional index (PNI) is a simple index comprised of serum albumin level and lymphocyte count which reflects the immunonutritional-inflammatory status. Recently, clinical studies have shown associations between the PNI and clinical outcomes in several cardiovascular diseases. The aim of the study was to assess the possible utilization of the PNI to predict the development of CA-AKI after primary PCI. METHODS We retrospectively included 836 patients (mean age 58 ± 12 years, 76% men) with STEMI treated with primary PCI. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The patients were divided into two groups according to whether or not CA-AKI developed. RESULTS The overall incidence of CA-AKI was 9.4%. Compared to the patients without CA-AKI, those with CA-AKI had a significantly lower PNI value (40.7 ± 3.7 vs. 35.2 ± 4.9; p < 0.001). In receiver operating characteristic curve analysis, the optimal cutoff value of the PNI to predict CA-AKI was 38, with 82% sensitivity and 70% specificity (area under the curve 0.836, p < 0.001). In multivariate logistic regression analysis, PNI < 38, body mass index and creatinine were independently associated with CA-AKI (odds ratio 11.275, 95% confidence interval 3.596-35.351; p < 0.001). CONCLUSIONS The PNI was inversely and significantly associated with the development of CA-AKI in acute STEMI. Assessing PNI at admission may be useful for early risk stratification of STEMI patients.
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Affiliation(s)
- Alparslan Kurtul
- Department of Cardiology, Hatay Mustafa Kemal University Faculty of Medicine, Hatay
| | - Murat Gok
- Cardiology Clinic, Edirne Sultan I. Murat State Hospital, Edirne
| | - Kerim Esenboga
- Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
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Association of lymphocyte-to-monocyte ratio with the long-term outcome after hospital discharge in patients with ST-elevation myocardial infarction: a retrospective cohort study. Coron Artery Dis 2021; 31:248-254. [PMID: 31658149 DOI: 10.1097/mca.0000000000000818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Lymphocyte-to-monocyte ratio (LMR), a novel systemic inflammatory factor, correlates with adverse outcomes in patients with cardiovascular disease. However, data are limited regarding the prognostic value of LMR in patients with ST-elevation myocardial infarction (STEMI) after hospital discharge. Therefore, the aim of our study was to evaluate the prognostic impact of admission LMR in hospital survivors of STEMI. METHODS This retrospective observational study enrolled 1369 STEMI patients between 2014 and 2017. The study population was divided into three groups according to tertiles (T) of LMR (T1: ≥2.84; T2: 1.85-2.83; T3: <1.85). The primary outcomes were long-term outcomes after discharge including major adverse cardiac events (MACE) and all-cause mortality. The associations between LMR and long-term outcomes were assessed using Cox regression analysis. RESULTS The median follow-up period was 556 days (interquartile range, 342-864 days). Independent correlations were observed between LMR and both long-term MACE and all-cause mortality. For long-term MACE, the T3 (adjusted hazard ratio [HR], 1.74; 95% confidence interval [CI]: 1.12-2.70; P = 0.013) and T2 groups (adjusted HR, 1.65; CI: 1.07-2.54; P = 0.024) showed significantly higher risk of MACE than did the T1 group. For long-term all-cause mortality, the adjusted HR was 3.07 (CI: 1.10-8.54; P = 0.032) in the T3 group and 2.35 (CI: 0.82-6.76; P = 0.112) in the T2 group compared with that of the T1 group. CONCLUSION Decreased admission LMR was independently associated with long-term all-cause mortality and MACE after discharge in patients with STEMI.
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Tavares F, Moraes PIM, Souza JM, Barbosa AH, Santos EM, Marcondes JA, Oliveira MD, Gonçalves I, Espírito Santo CVA, Bianco HT, Fonseca FAH, Moisés V, Caixeta A. Prognostic role of neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing to pharmaco-invasive strategy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:99-103. [PMID: 33736961 DOI: 10.1016/j.carrev.2021.01.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We sought to determine the relationship between in-hospital mortality and the neutrophil-to-lymphocyte ratio (NLR) in patients with ST-elevation myocardial infarction (STEMI) undergoing with pharmaco-invasive strategy (PIS). BACKGROUND Increased levels of white blood cells have been associated with adverse clinical outcomes in patients with (STEMI). NLR has recently emerged as a potent and more specific prognostic marker in predicting short- and long-term mortalityin patients undergoing primary percutaneous coronary intervention. This association has never been reported in patients managed with PIS. METHODS Between March 2010 and October 2016, 1860 STEMI patients managed with PIS were consecutively included in a dedicated database. The study population was divided into tertiles based on the admission NLR values (lower: <4.0, intermediate: 4.0 to <7.3, and upper: ≥7.3). Co-primary endpoints were in-hospital mortality and MACE (death, non-fatal reinfarction or stent thrombosis). RESULTS Patients in the upper NLR tertile had significantly higher in-hospital mortality (9.0% vs. 4.8% versus. 1.8%, p < 0.001) and MACE (11.6% vs. 8.0% versus 2.9%, p < 0.001) than patients with intermediate or low NLR. By multivariable logistic regression analysis, the upper NLR tertile was an independent predictor of MACE (odds radio [OR] 4.19, 95% confidence interval [95% CI] 2.23-7.88, p < 0.001) and in-hospital mortality [OR 3.32, 95% CI 1.19-9.28, p = 0.02]. CONCLUSION High NLR values were independently associated with in-hospital MACE and death in STEMI patients submitted to a PIS. NLR might be a simple and useful risk stratification tool in this high-risk population.
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Affiliation(s)
- Fernando Tavares
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Pedro I M Moraes
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - José Marconi Souza
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Adriano H Barbosa
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Eduardo M Santos
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - José Augusto Marcondes
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Marcos Danillo Oliveira
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Iran Gonçalves
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | | | - Henrique T Bianco
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Francisco A H Fonseca
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Valdir Moisés
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Adriano Caixeta
- Department of Interventional Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil.
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Association of platelet to lymphocyte ratio with in-hospital major adverse cardiovascular events and the severity of coronary artery disease assessed by the Gensini score in patients with acute myocardial infarction. Chin Med J (Engl) 2020; 133:415-423. [PMID: 31977557 PMCID: PMC7046248 DOI: 10.1097/cm9.0000000000000650] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The platelet to lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker and has been shown to be significantly associated with atherosclerotic coronary artery disease (CAD). Therefore, we aimed to explore the association of PLR with in-hospital major adverse cardiovascular events (MACEs) and the severity of CAD assessed by the Gensini score (GS) in patients with acute myocardial infarction (AMI) undergoing coronary angiography. Methods: A total of 502 patients with AMI consecutively treated at the Affiliated Hospital of Qingdao University (Qingdao, China) and underwent coronary angiography from August 2017 to December 2018 were recruited in this study. The demographic, clinical, angiographic characteristics, and laboratory parameters were collected. According to the presence of in-hospital MACEs, the included patients were divided into the MACE group (n = 81) and the non-MACE group (n = 421). Further, according to tertiles of the GS, the patients were classified into three groups: the low GS group (GS ≤ 32 points, n = 173), medium GS group (32 points < GS ≤ 60 points, n = 169), and high GS group (60 points < GS ≤ 180 points, n = 160). The main statistical methods included Chi-squared test, non-parametric Mann-Whitney U test, Kruskal-Wallis H test, logistic regression, and receiver operating characteristic curves. Results: The PLR in the MACE group was significantly higher than that in the non-MACE group (179.43 [132.84, 239.74] vs. 116.11 [87.98, 145.45], Z = –8.109, P < 0.001). Further, there were significant differences in PLR among the tertiles of GS (110.05 [84.57, 139.06] vs. 119.78 [98.44, 157.98] vs. 140.00 [102.27, 191.83], H = 19.524, P < 0.001). PLR was demonstrated to be an independent risk factor of in-hospital MACEs (odds ratio [OR]: 1.012, 95% confidential interval [CI]: 1.006–1.018, P < 0.001) and severe CAD assessed by the GS (OR: 1.004, 95% CI: 1.002–1.009, P = 0.042). The cutoff value of PLR for predicting the development of in-hospital MACEs was 151.28 with a sensitivity of 66.7% and a specificity of 78.1% (area under the curve [AUC]: 0.786, 95% CI: 0.730–0.842, P < 0.001), and a PLR of 139.31 was also identified to be an effective cutoff point for detecting a high GS (>60 points) with a sensitivity of 49.4% and a specificity of 69.6% (AUC: 0.611, 95% CI: 0.556–0.666, P < 0.001). Conclusions: PLR as a novel inflammatory marker is significantly and independently associated with the occurrence of in-hospital MACEs and the severity of CAD assessed by the GS in patients with AMI. As an easily available and inexpensive inflammatory indicator, PLR could be widely used as an efficient inflammatory biomarker for identifying high-risk patients and for individualizing targeted therapy to improve the prognosis of AMI.
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Cankurt T, Celik İE, Ozturk S, Maden O. Inflammatory Conditions in Acute Coronary Syndrome Patients Treated with Percutaneous Coronary Intervention of Saphenous Vein Graft. Int J Angiol 2020; 29:237-244. [PMID: 33268974 PMCID: PMC7690989 DOI: 10.1055/s-0040-1714751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The study aimed to evaluate the inflammatory blood parameters in acute coronary syndrome (ACS) patients with a history of coronary artery bypass graft (CABG) and treated with percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). A total of 347 patients who underwent urgent SVG PCI with the diagnosis of ACS were included in the study. After the application of exclusion criteria, 79 patients were allocated into two groups, namely, successful PCI ( n = 59) and unsuccessful PCI ( n = 20), and included in the statistical analysis. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) levels were significantly higher in patients with unsuccessful SVG PCI. In the logistic regression analysis, PLR, C-reactive protein, and diabetes mellitus emerged as independent factors associated with unsuccessful SVG PCI. The area under the curve for PLR was 0.70 (95% confidence interval: 0.55-0.85, p = 0.006). The cut-off value of PLR (128.99) was associated with 70.0% sensitivity and 69.5% specificity. Elevated inflammatory status is associated with unsuccessful PCI of SVG in ACS patients. Increased PLR levels on admission is an independent predictor of this situation. This cheap and simple marker can help us to predict unsuccessful SVG PCI in ACS patients.
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Affiliation(s)
- Tayyar Cankurt
- Cardiology Clinic, Amasya University Sabuncuoglu Sereefeddin State Hospital, Ankara, Turkey
| | - İbrahim E. Celik
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
| | - Selcuk Ozturk
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
| | - Orhan Maden
- Department of Cardiology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
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11
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Kacer P, Adamkova V, Hubacek JA, Cervinkova T, Adamek V, Kralova Lesna I, Lanska V, Pirk J. Post-infarction left ventricular free wall rupture: 12-years experience from the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague, Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:408-415. [PMID: 32808602 DOI: 10.5507/bp.2020.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Post-infarction left ventricular free wall rupture (LVFWR) is a feared and catastrophic complication of myocardial infarction that carries a high surgical and hospital mortality. Due to the rarity of this complication, little information exists on surgical treatment and outcomes. Goal and Methods. The goal of this study was to present our experience with LVFWR. We present a retrospective cohort of 19 consecutive patients who were surgically treated in the Cardiac Centre of the Institute of Clinical and Experimental Medicine in Prague between January 2006 and December 2017. RESULTS Thirty-day mortality was 26%. Five patients died. Four patients died in the operating theatre and one patient on the ninth postoperative day following re-rupture. Seventy-four percent of the patient cohort survived and were discharged from hospital. The median length of follow-up was 45 months (range 0.75-150). No patient died during follow-up. Median postoperative ejection fraction was 45% (range 25-65%). Angina pectoris and dyspnea were investigated during follow-up and graded according to the Canadian cardiology society (CCS) and the New York Heart Association (NYHA) classifications. Fourteen patients had CCS class I, eight patients had NYHA class I dyspnea and six patients had NYHA class II. Re-rupture occurred after hospital discharge in one patient one month after the original surgery. The patient was treated successfully by urgent surgical intervention. CONCLUSION LVFWR is a catastrophic and challenging complication of myocardial infarction. Good outcomes can be achieved by rapid diagnosis and urgent surgical intervention as shown by our results.
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Affiliation(s)
- Petr Kacer
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Adamkova
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Tereza Cervinkova
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Ivana Kralova Lesna
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Lanska
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Pirk
- Cardiac Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
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12
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Mikhael R, Hindoro E, Taner S, Lukito AA. Neutrophil-to-lymphocyte ratio for predictor of in-hospital mortality in ST-segment elevation myocardial infarction: a meta-analysis. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.202795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is the most life-threatening condition of acute coronary syndrome that carries a poor prognosis of in-hospital mortality. Multiple scoring systems have been developed to predict in-hospital mortality and other cardiovascular events. Neutrophil-to-lymphocyte ratio (NLR) is hardly used as a predictor of in-hospital mortality. This study was aimed to determine the predictive value of NLR concerning in-hospital mortality in STEMI patients.
METHODS Literature search and pooled analysis related to studies on MEDLINE/PubMed, EBSCO, Science Direct, Cochrane, and ProQuest were retrieved. Inclusion criteria were met if they were cohort studies, the subjects were STEMI patient, contained pretreatment NLR cut-off, and considered in-hospital mortality, which is defined as cardiac or all-cause mortality. Quality assessment was conducted using Newcastle-Ottawa scale. Review Manager version 5.3 (The Nordic Cochrane Centre, Copenhagen) was used for meta-analysis.
RESULTS We found 12 studies with a total of 7,251 STEMI subjects with median NLR cut-off value of 5.6. Elevated NLR on admission carries a high risk of in-hospital mortality (odds ratio [OR] = 3.00, 95% confidence interval [CI] = 2.46–3.67). A slightly higher risk of all-cause mortality (OR = 2.74, 95% CI = 1.99–3.77) was observed compared with cardiac-related mortality (OR = 3.20, 95% CI = 2.47–4.14). No significant heterogeneity was observed between these studies (p = 0.46, I2 = 0%).
CONCLUSIONS Elevated NLR predicts a higher in-hospital mortality rate of STEMI patients.
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13
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Zorlu C, Koseoglu C. Comparison of the Relationship Between Inflammatory Markers and Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome After Coronary Angiography. Angiology 2019; 71:249-255. [PMID: 31808357 DOI: 10.1177/0003319719892160] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Contrast-induced nephropathy (CIN) is one of the most important complications after invasive cardiovascular procedures. The neutrophil-to-lymphocyte ratio (NLR), mean platelet volume-to-lymphocyte ratio (MPVLR), and platelet-to-lymphocyte ratio (PLR) may be markers of the risk of CIN. We aimed to investigate the association of these indices with the development of CIN in patients with ST-elevation myocardial infarction and non-ST-elevation-acute coronary syndrome who underwent percutaneous coronary intervention. We retrospectively collected the data of patients with ACS after coronary angiography (CA); 564 patients were included (mean age, 62.3 ± 13.0 years; 41.1% female). We compared 62 (10.9%) patients who developed CIN and 502 patients who did not, after CA in terms of NLR, PLR, and MPVLR. Patients who developed CIN had significantly higher MPVLR, NLR, and PLR; the MPVLR (P ≤ .001) was an independent predictor of CIN. NLR, MPVLR, and PLR are simple, cheap, and easily accessible tests that can predict CIN; the MPVLR was the strongest of these predictors.
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Affiliation(s)
- Cagri Zorlu
- Department of Cardiology, Tokat State Hospital, Tokat, Turkey
| | - Cemal Koseoglu
- Department of Cardiology, Tokat State Hospital, Tokat, Turkey
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14
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Prognostic nutritional index may not be a good prognostic indicator for acute myocardial infarction. Sci Rep 2019; 9:14717. [PMID: 31605003 PMCID: PMC6789006 DOI: 10.1038/s41598-019-51044-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/23/2019] [Indexed: 02/05/2023] Open
Abstract
The prognostic nutritional index (PNI) has been applied in acute myocardial infarction (AMI) recently.However, the application of PNI in AMI needs verification. This was a prospective cohort study. Patients diagnosed with AMI were enrolled. PNI was calculated as (serum albumin (SA in g/L)) + (5 × total lymphocyte count (TLC) × 109/L). Modified PNI (mPNI) was analyzed by logistic regression analysis to reset the proportion of SA and TLC. The primary outcome was all-cause death. A total of 598 patients were enrolled; 73 patients died during follow-up. The coefficient of SA and TLC in the mPNI formula was approximately 2:1. The area under the receiver operating characteristic curve of SA, TLC, PNI, mPNI and GRACE in predicting death for patients with AMI was 0.718, 0.540, 0.636, 0.721 and 0.825, respectively. Net reclassification improvement (NRI) between PNI and mPNI was 0.230 (p < 0.001). Integrated discrimination improvement (IDI) was 0.042 (p = 0.001). Decision curve analysis revealed that mPNI had better prognostic value for patients with AMI than PNI; however, it was not superior to SA. Thus, PNI may not a reliable prognostic predictor of AMI; after resetting the formula, the value of PNI in predicting prognosis of AMI is almost entirely due to SA.
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15
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Kalayci B, Kaçmaz C, Köktürk F. Platelet lymphocyte ratio and neutrophil lymphocyte ratio are predictors of ST segment resolution following thrombolytic treatment. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Zhang S, Diao J, Qi C, Jin J, Li L, Gao X, Gong L, Wu W. Predictive value of neutrophil to lymphocyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis. BMC Cardiovasc Disord 2018; 18:75. [PMID: 29716535 PMCID: PMC5930503 DOI: 10.1186/s12872-018-0812-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/20/2018] [Indexed: 01/11/2023] Open
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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Affiliation(s)
- Sai Zhang
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jun Diao
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chunmei Qi
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jingjing Jin
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Li Li
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xingjuan Gao
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lei Gong
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Weiheng Wu
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China. .,The Second Affiliated Hospital of Xuzhou Medical University, 32th Meijian Road, 221000, Xuzhou, Jiangsu, People's Republic of China.
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17
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Usefulness of Mean Platelet Volume-to-Lymphocyte Ratio for Predicting Angiographic No-Reflow and Short-Term Prognosis After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017. [PMID: 28633762 DOI: 10.1016/j.amjcard.2017.05.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary percutaneous coronary intervention (pPCI) is associated with improved prognosis in patients with ST-segment elevation myocardial infarction (STEMI). However, no-reflow phenomenon limits the benefit of revascularization and predicts adverse outcomes. The specific mechanism for its occurrence is still not entirely clear, and it is believed at present that platelet activation and inflammation play a pivotal role in developing no-reflow. Both increased mean platelet volume (MPV), which is a platelet activation marker, and lymphopenia, which is an inflammation marker, have been linked to adverse events and poor prognosis after STEMI. Recently, MPV-to-lymphocyte ratio (MPVLR) has emerged as a novel marker of poor short- and long-term prognosis in diabetic patients with STEMI who underwent pPCI. In this study, we aimed to investigate whether MPVLR predicts angiographic no-reflow and in-hospital mortality in all STEMI patients. From January 2014 to January 2017, a total of 1,206 patients who underwent pPCI, admitted within 12 hours from symptom onset, were enrolled and divided into 2 groups based on the final thrombolysis in myocardial infarction (TIMI) flow grading. No-reflow was defined as post-pPCI TIMI grade 0, 1, and 2 flows and normal-reflow was defined as TIMI 3 flow. The incidence of no-reflow was 16.1% (n = 198). The MPVLR values were higher in no-reflow group than in normal-reflow group (p <0.001). In multivariate analysis, MPVLR was an independent predictor of angiographic no-reflow. Furthermore, in multivariable Cox regression models adjusted for potential confounders, MPVLR was independently and positively associated with the hazard of 30-day all-cause mortality. In conclusion, the MPVLR was a strong independent predictor for angiographic no-reflow and short-term mortality in patients with STEMI who underwent pPCI.
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18
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Kurtul A, Ozturk S. WITHDRAWN: Relation of Mean Platelet Volume-to-Lymphocyte Ratio and Contrast-Induced Acute Kidney Injury in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2017:S0002-9149(17)31290-0. [PMID: 28918942 DOI: 10.1016/j.amjcard.2017.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Alparslan Kurtul
- Ankara Education and Research Hospital, Department of Cardiology, Ankara, Turkey.
| | - Selcuk Ozturk
- Ankara Education and Research Hospital, Department of Cardiology, Ankara, Turkey
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19
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Wang Q, Ma J, Jiang Z, Wu F, Ping J, Ming L. Association of lymphocyte-to-monocyte ratio with in-hospital and long-term major adverse cardiac and cerebrovascular events in patients with ST-elevated myocardial infarction. Medicine (Baltimore) 2017; 96:e7897. [PMID: 28834908 PMCID: PMC5572030 DOI: 10.1097/md.0000000000007897] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In recent years, lymphocyte-to-monocyte ratio (LMR) has become a novel indirect marker of inflammation, which has been demonstrated to be associated with poor prognosis of oncology and cardiovascular disease. The aim of the study was to assess the relationship between LMR on admission and in-hospital and long-term major adverse cardiac and cerebrovascular events (MACCE) in patients with ST-elevated myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI).A total of 306 STEMI patients were enrolled and grouped according to tertiles of LMR from the blood samples obtained in the emergency room on admission. Total white blood cell count, differential count of neutrophil, lymphocyte, monocyte, and other factors were evaluated.The median follow-up period was 21 months (1-36 months). As the LMR decreased, in-hospital nonfatal myocardial infarction and cardiovascular mortality increased (P = .002, P = .009, respectively). And long-term stroke/TIA, TVR, nonfatal myocardial infarction, and cardiovascular mortality also increased with decreasing LMR (P = .012, P = .001, P = .003, P = .002, respectively). The receiver operating characteristic (ROC) curve of LMR for predicting MACCE showed the sensitivity of 76% and specificity of 78% and the optimal cut-off value was determined as 2.62. In multivariate analysis, after adjusting for confounders, LMR was an independent predictor of in-hospital and long-term MACCE (odds ratio [OR] 1.192 [1.069-1.315] P < .001, OR 1.239 [1.125-1.347] P < .001, respectively).The LMR is an independent predictor of in-hospital and long-term MACCE in patients with STEMI after primary PCI. Our results suggest that this simple, inexpensive, relatively available inflammatory marker may have significant effects on the treatment and prognosis in patients with STEMI.
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20
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Ozturk S, Kurtul A. WITHDRAWN: Lymphocyte-to-monocyte ratio is an independent predictor for higher SYNTAX scores and associated with adverse events in acute coronary syndrome. Int J Cardiol 2017:S0167-5273(17)32318-5. [PMID: 28728849 DOI: 10.1016/j.ijcard.2017.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/30/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Selcuk Ozturk
- Ankara Research and Training Hospital, Department of Cardiology, Ankara, Turkey.
| | - Alparslan Kurtul
- Ankara Research and Training Hospital, Department of Cardiology, Ankara, Turkey
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Chen QJ, Qu HJ, Li DZ, Li XM, Zhu JJ, Xiang Y, Li L, Ma YT, Yang YN. Prognostic nutritional index predicts clinical outcome in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Sci Rep 2017; 7:3285. [PMID: 28607442 PMCID: PMC5468272 DOI: 10.1038/s41598-017-03364-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 04/27/2017] [Indexed: 02/05/2023] Open
Abstract
We aimed to investigate whether the prognostic nutritional index (PNI), a combined nutritional-inflammatory score based on serum albumin levels and lymphocyte count, was associated with mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). From September 2011 to November 2014, 309 consecutive patients with STEMI undergoing pPCI were prospectively enrolled. Patients with a combined score of albumin (g/L) + 5 × total lymphocyte count × 109/L ≥ 45 or <45 were assigned a PNI score of 0 or 1, respectively. Of the 309 STEMI patients, 24 (7.74%) died in the hospital, and 15 (4.83%) died during long-term follow-up (median follow-up time, 19.5 [3–36] months). Compared to patients with a PNI of 0, patients with a PNI of 1 had significantly higher in-hospital (14.2% vs. 3.7%; P < 0.001) and long-term follow-up (21.7% vs. 6.9%, P < 0.001) mortality rates. PNI (1/0, HR, 2.414; 95% CI, 1.016 to 5.736; P = 0.046) was a significant independent predictor of mortality in patients with STEMI undergoing pPCI. Moreover, cumulative survival was significantly lower for patients with a PNI of 1 compared to patients with a PNI of 0 (78.3% vs. 93.1%, log-rank P < 0.001). PNI appears useful for the risk stratification of STEMI patients undergoing pPCI.
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Affiliation(s)
- Qing-Jie Chen
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China
| | - Hui-Juan Qu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China
| | - Dong-Ze Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao-Mei Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China
| | - Jia-Jun Zhu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China
| | - Yang Xiang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China
| | - Lei Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China
| | - Yi-Ning Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. .,Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi, China.
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22
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Increased maximum p wave duration in smoking patients with ST-elevation acute myocardial infarction and its relationship with inflammatory markers. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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23
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Kiris T, Çelik A, Variş E, Akan E, Akyildiz ZI, Karaca M, Nazli C, Dogan A. Association of Lymphocyte-to-Monocyte Ratio With the Mortality in Patients With ST-Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention. Angiology 2017; 68:707-715. [PMID: 28056530 DOI: 10.1177/0003319716685480] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated whether the lymphocyte-to-monocyte ratio (LMR) 48 hours after admission is related to 30-day and long-term mortality in patients with ST-elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI). We evaluated 318 consecutive patients with STEMI who were undergoing primary PCI. The relationship between the LMR48h and all-cause mortality (30-day and long-term) was analyzed by categorizing the patients into tertiles (T) according to LMR48h-T1 (>2.46), T2 (1.67-2.46), and T3 (<1.67). The T3 group exhibited the highest risk of 30-day all-cause mortality (hazard ratio [HR]: 8.093 [1.006-65.074]; P = .049). For long-term mortality, a significantly higher mortality risk was observed in both T2 (HR: 2.005 [1.021-3.939]; P = .043) and T3 groups (HR: 2.374 [1.160-4.857]; P < .001) compared to the T1 group (reference group). In multivariate analysis, these associations remained unaltered even after adjusting for confounders. A low LMR at 48 hours after admission may be independently associated with both 30-day and long-term mortality in patients with STEMI who were treated with primary PCI. This marker may be used for identifying patients with STEMI at high risk.
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Affiliation(s)
- Tuncay Kiris
- 1 Department of Cardiology, Ataturk Training and Research Hospital, Medical School, Izmir Katip Celebi University, Izmir Turkey
| | - Aykan Çelik
- 1 Department of Cardiology, Ataturk Training and Research Hospital, Medical School, Izmir Katip Celebi University, Izmir Turkey
| | - Eser Variş
- 1 Department of Cardiology, Ataturk Training and Research Hospital, Medical School, Izmir Katip Celebi University, Izmir Turkey
| | - Erol Akan
- 1 Department of Cardiology, Ataturk Training and Research Hospital, Medical School, Izmir Katip Celebi University, Izmir Turkey
| | - Zehra Ilke Akyildiz
- 1 Department of Cardiology, Ataturk Training and Research Hospital, Medical School, Izmir Katip Celebi University, Izmir Turkey
| | - Mustafa Karaca
- 1 Department of Cardiology, Ataturk Training and Research Hospital, Medical School, Izmir Katip Celebi University, Izmir Turkey
| | - Cem Nazli
- 1 Department of Cardiology, Ataturk Training and Research Hospital, Medical School, Izmir Katip Celebi University, Izmir Turkey
| | - Abdullah Dogan
- 1 Department of Cardiology, Ataturk Training and Research Hospital, Medical School, Izmir Katip Celebi University, Izmir Turkey
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Ertem AG, Yayla C, Acar B, Kirbas O, Unal S, Uzel Sener M, Akboga MK, Efe TH, Sivri S, Sen F, Gokaslan S, Topaloglu S. Relation between lymphocyte to monocyte ratio and short-term mortality in patients with acute pulmonary embolism. CLINICAL RESPIRATORY JOURNAL 2016; 12:580-586. [PMID: 27727508 DOI: 10.1111/crj.12565] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/13/2016] [Accepted: 08/29/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The relationship between inflammation and mortality after acute pulmonary embolism (APE) has previously been investigated with different variables (platelet/lymphocyte ratio, etc). OBJECTIVES We investigated the predictive value of lymphocyte to monocyte ratio (LMR) for mortality in first 30 days after APE. METHODS The study population included 264 APE patients of which 230 patients were survivors, 34 patients were non-survivors. RESULTS LMR was significantly lower in non-survivors after APE (P < .001). Neutrophil-to-lymphocyte ratio (NLR) was higher in non-survivors after APE (P < .001). Platelet-to-lymphocyte (PLR) had no significance between both groups (P: .241). Simplified pulmonary embolism severity index and LMR were independent predictors of mortality in patients with APE (P: .008 and P: .001, respectively). CONCLUSION LMR as a novel marker of inflammation seemed to be an independent predictor of short-term mortality in patients with APE.
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Affiliation(s)
- Ahmet Goktug Ertem
- Department of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Cagri Yayla
- Department of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Burak Acar
- Department of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ozgur Kirbas
- Department of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Sefa Unal
- Department of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Melahat Uzel Sener
- Department of Chest Diseases, Ataturk Heart Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Mehmet Kadri Akboga
- Department of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Tolga Han Efe
- Department of Cardiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Serkan Sivri
- Department of Cardiology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Fatih Sen
- Department of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Gokaslan
- Department of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
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Yayla Ç, Akboğa MK, Gayretli Yayla K, Ertem AG, Efe TH, Şen F, Ünal S, Açar B, Özcan F, Turak O, Özeke Ö. A novel marker of inflammation in patients with slow coronary flow: lymphocyte-to-monocyte ratio. Biomark Med 2016; 10:485-93. [PMID: 27089433 DOI: 10.2217/bmm-2016-0022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Recently, lymphocyte-to-monocyte ratio (LMR) has emerged as a new indirect marker of inflammation which is associated with adverse outcomes in oncology and cardiovascular diseases. The aim of the study was to evaluate the relationship between LMR and slow coronary flow (SCF). PATIENTS & METHODS A total of 100 consecutive patients with SCF and 100 consecutive patients with normal coronary flow were enrolled in this study. RESULTS LMR was significantly lower in patients with SCF than in patients with normal coronary flow (p < 0.001). Also, LMR was negatively correlated with neutrophil-to-lymphocyte ratio and CRP levels (p < 0.001 and p = 0.005). LMR was found to be significantly and independently associated with SCF (p = 0.033). CONCLUSION LMR was negatively correlated with serum C-reactive protein and neutrophil-to-lymphocyte ratio levels.
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Affiliation(s)
- Çağrı Yayla
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mehmet Kadri Akboğa
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- Dışkapı Yıldırım Beyazıt Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Ahmet Göktuğ Ertem
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Tolga Han Efe
- Dışkapı Yıldırım Beyazıt Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Fatih Şen
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Sefa Ünal
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Burak Açar
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Fırat Özcan
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Osman Turak
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Özcan Özeke
- Türkiye Yüksek Ihtisas Training & Research Hospital, Cardiology Clinic, Ankara, Turkey
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Koseoglu HI, Altunkas F, Kanbay A, Doruk S, Etikan I, Demir O. Platelet-lymphocyte ratio is an independent predictor for cardiovascular disease in obstructive sleep apnea syndrome. J Thromb Thrombolysis 2016; 39:179-85. [PMID: 25002338 DOI: 10.1007/s11239-014-1103-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There is a strong relationship between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease (CVD). Chronic intermittent hypoxia, inflammation, oxidative stress, and endothelial dysfunction may constitute etiologic mechanisms, linking OSAS to CVD. Inflammation play an important role in the development of CVD. Platelet-lymphocyte ratio (PLR) is a new biomarker showing inflammation. No previous study has ever investigated the association between PLR, CVD and OSAS severity in patients with OSAS. This study was designed to investigate the association between PLR and CVD in patients with OSAS, and relationship between severity of OSAS, polysomnographic parameters and PLR. This was a cohort study in which patients who had undergone a full night polysomnoraphy for diagnosis of OSA were recruited. Patients were divided according to their apnea-hypopnea index (AHI) scores into OSAS negative (Group 1: AHI < 5), mild (Group 2: AHI, 5-15), moderate (Group 3:AHI,15-30), and severe OSAS (Group 4: AHI > 30) groups. The presence of heart failure, coronary artery disease or arrhythmia was defined as CVD. A total of 424 patients were included in this study. There were 57, 93, 82, and 192 patients in Groups 1, 2, 3, and 4, respectively. PLR were significantly different between groups (Group 1: 87.38; Group 2: 95.07; Group 3: 97.01, Group 4: 126.9, P < 0.05). PLR were significantly correlated with AHI, oxygen desaturation index, average and minimum O2 saturation values (P < 0.05). Values of PLR were significantly higher in patients with CVD compared with those without. Multiple regression analysis demonstrated that PLR is an independent predictor of CVD. PLR cut-off value for demonstrating the presence of CVD is higher than 108.56. In the light oh findings, PLR is strongly associated with the severity of OSAS and cardiovascular disease in OSAS patients. PLR might be used as a biomarker to predict CVD in OSAS patients.
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Association of lymphocyte-to-monocyte ratio with the no-reflow phenomenon in patients who underwent a primary percutaneous coronary intervention for ST-elevation myocardial infarction. Coron Artery Dis 2015; 26:706-12. [DOI: 10.1097/mca.0000000000000301] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome. Rev Port Cardiol 2015; 34:465-71. [DOI: 10.1016/j.repc.2015.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 01/04/2023] Open
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Soylu K, Gedikli Ö, Dagasan G, Aydin E, Aksan G, Nar G, İnci S, Yilmaz Ö. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Ipek G, Onuk T, Karatas MB, Güngör B, Atasoy I, Murat A, Aldag M, Yelgec NS, Dayi SU, Bolca O. Relationship between Neutrophil-to-Lymphocyte Ratio and Left Ventricular Free Wall Rupture in Acute Myocardial Infarction. Cardiology 2015; 132:105-110. [PMID: 26139385 DOI: 10.1159/000431354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/11/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to evaluate the relationship between the neutrophil-to-lymphocyte (N/L) ratio and left ventricular free wall rupture (LVFWR) in patients with ST elevation myocardial infarction (STEMI). Previous studies showed a correlation between increased levels of inflammatory markers and adverse cardiovascular events. The role of inflammation markers, particularly the N/L ratio, in mechanical complications after myocardial infarction has not been studied. METHODS Retrospectively, we compared the N/L ratio values of 23 patients with STEMI complicated by LVFWR with 214 STEMI patients without this complication. The diagnosis of rupture was confirmed by echocardiography in each case. RESULTS Neutrophil counts [median 8.5 × 103/µl, interquartile range (IQR) 6.4, vs. 7.8 × 103/µl, IQR 4.7, p = 0.02] and the N/L ratio (5.66, IQR 4.17, vs. 4.1, IQR 3.93, p = 0.01) were significantly higher in the LVFWR group. In receiver operating characteristic analysis, an N/L ratio above 3.7 predicted LVFWR with a sensitivity of 82.6% and a specificity of 46.9% (area under the curve = 0.654, p = 0.016). In multivariate regression analysis, age, hypertension, increased creatinine levels and increased N/L ratio (odds ratio = 1.61, 95% confidence interval = 1.15-2.23, p = 0.01) were found to be independent predictors of LVFWR. CONCLUSIONS In our study, the N/L ratio was found to be independently correlated with the risk of LVFWR. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Gokturk Ipek
- Department of Cardiology, Siyami Ersek Cardiothoracic Surgery Center, Istanbul, Turkey
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Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and long-term adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:288-97. [PMID: 26677378 PMCID: PMC4679796 DOI: 10.5114/pwki.2015.55599] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/07/2015] [Accepted: 08/11/2015] [Indexed: 02/08/2023] Open
Abstract
Introduction Platelet/lymphocyte ratio (PLR) has been shown to be an inflammatory and thrombotic biomarker for coronary heart disease, but its prognostic value in ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. Aim To investigate the relationship between PLR and no-reflow, along with the in-hospital and long-term outcomes in patients with STEMI. Material and methods In the present study, we included 304 consecutive patients suffering from STEMI who underwent primary percutaneous coronary intervention (p-PCI). Patients were stratified according to PLR tertiles based on the blood samples obtained in the emergency room upon admission. No-reflow after p-PCI was defined as a coronary thrombolysis in myocardial infarction (TIMI) flow grade ≤ 2 after vessel recanalization, or TIMI flow grade 3 together with a final myocardial blush grade (MBG) < 2. Results The mean follow-up period was 24 months (range: 22–26 months). The number of patients characterized with no-reflow was counted to depict increments throughout successive PLR tertiles (14% vs. 20% vs. 45%, p < 0.001). In-hospital major adverse cardiovascular events and death increased as the PLR increased (p < 0.001, p < 0.001). Long-term MACE and death also increased as the PLR increased (p < 0.001, p < 0.001). Multivariable logistic regression analysis revealed that PLR remained an independent predictor for both in-hospital (OR = 1.01, 95% CI: 1.00–1.01; p = 0.002) and major long-term (OR = 1.01, 95% CI: 1.00–1.01; p < 0.001) adverse cardiac events. Conclusions Platelet/lymphocyte ratio on admission is a strong and independent predictor of both the no-reflow phenomenon and long-term prognosis following p-PCI in patients with STEMI.
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Chou YIS, Kong J, Song R, Yan L, Zheng L, Zhang Y. Correlations of platelet-derived microparticles with thromboxane B2, platelet-activating factor, endothelin-1, and neutrophil to lymphocyte ratio in patients with coronary intermediate lesions. Biomarkers 2014; 19:684-92. [DOI: 10.3109/1354750x.2014.981293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Spontaneous early patency of infarct-related artery (IRA) on arrival for primary percutaneous coronary intervention is associated with better short- and long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to investigate whether the hemographic parameters on admission are associated with spontaneous IRA patency. METHODS This was a retrospective study of 1,625 patients with acute STEMI who underwent primary percutaneous coronary intervention<12 hours after the onset of symptoms. RESULTS Angiography showed patent IRA (prethrombolysis in myocardial infarction [TIMI] grade 3 flow) in 160 (9.8%) patients. Neutrophil count on admission (7.8±2.4×10³/μL versus 9.7±3.8×10³/μL; P<0.001) was significantly lower and lymphocyte count (2.4±1.0×10³/μL versus 1.9±1.1×10³/μL; P<0.001) on admission was significantly higher in the patent IRA group. Neutrophil to lymphocyte ratio (NLR) was significantly lower in the patent IRA group (4.1±3.2 versus 6.9±5.5; P<0.001). Admission leukocyte counts (13±4.0×10³/μL versus 12±3.4×10³/μL; P<0.001) and NLR (7.2±5.8 versus 5.5±4.4; P<0.001) of the patients with TIMI thrombus score≥4 were significantly higher than patients with TIMI thrombus score<4. In the multivariate analysis, NLR≥4.5 (3.17 [95% confidence interval: 2.04-4.92]; P<0.001) was found to be independently predicting an occluded IRA on initial angiography with a sensitivity of 62.7% and a specificity of 70%. CONCLUSIONS NLR on admission is significantly related to angiographic thrombus burden and spontaneous early IRA patency in patients with acute STEMI.
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Han YC, Yang TH, Kim DI, Jin HY, Chung SR, Seo JS, Jang JS, Kim DK, Kim DK, Kim KH, Seol SH, Kim DS. Neutrophil to Lymphocyte Ratio Predicts Long-Term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Korean Circ J 2013; 43:93-9. [PMID: 23508782 PMCID: PMC3596670 DOI: 10.4070/kcj.2013.43.2.93] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/08/2012] [Accepted: 10/16/2012] [Indexed: 01/04/2023] Open
Abstract
Background and Objectives A higher neutrophil to lymphocyte ratio (NLR) has been associated with poor clinical outcomes in various cardiac diseases. However, the clinical availability of NLR in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been known. We evaluated the availability of NLR to predict clinical outcomes in patients with STEMI undergoing primary PCI. Subjects and Methods We analyzed 326 consecutive STEMI patients treated with primary PCI. The patients were divided into tertiles according to NLR: NLR≤3.30 (n=108), 3.31<NLR≤6.52 (n=108) and NLR>6.53 (n=110). We evaluated the incidence of major adverse cardiac events (MACE), a composite of all causes of death, non-fatal MI, and ischemic stroke at the 12-month follow-up. Results The high NLR group was associated with a significantly higher rate of 12-month MACE (19.1% vs. 3.7%, p<0.001), 12-month death (18.2% vs. 2.8%, p<0.001), in-hospital MACE (12.7% vs. 2.8%, p=0.010) and in-hospital death (12.7% vs. 1.9%, p=0.003) compared to the low NLR group. In the multivariable model, high NLR was an independent predictor of 12-month MACE {hazard ratio (HR) 3.33 (1.09-10.16), p=0.035} and death {HR 4.10 (1.17-14.46), p=0.028} after adjustment for gender, left ventricular ejection fraction, creatinine clearance, angiographic parameters and factors included in the Thrombolysis in Myocardial Infarction risk score for STEMI. There was a significant gradient of 12-month MACE across the NLR tertiles with a markedly increased MACE hazard in the high NLR group (log rank test p=0.002). Conclusion The NLR is a useful marker to predict 12-month MACE and death in patients with STEMI who have undergone primary PCI.
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Affiliation(s)
- Yang-Chun Han
- Division of Cardiology, Department of Internal Medicine, Changwon Fatima Hospital, Changwon, Korea
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Ergelen M, Uyarel H, Altay S, Kul Ş, Ayhan E, Isık T, Kemaloğlu T, Gül M, Sönmez O, Erdoğan E, Turfan M. Predictive value of elevated neutrophil to lymphocyte ratio in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction. Clin Appl Thromb Hemost 2013; 20:427-32. [PMID: 23314674 DOI: 10.1177/1076029612473516] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The neutrophil to lymphocyte ratio (NLR) has been investigated as a new predictor for cardiovascular risk. Admission NLR would be predictive of adverse outcomes after primary angioplasty for ST-segment elevation myocardial infarction (STEMI). METHODS A total of 2410 patients with STEMI undergoing primary angioplasty were retrospectively enrolled. The study population was divided into tertiles based on the NLR values. A high NLR (n = 803) was defined as a value in the third tertile (>6.97), and a low NLR (n = 1607) was defined as a value in the lower 2 tertiles (≤6.97). RESULTS High NLR group had higher incidence of inhospital and long-term cardiovascular mortality (5% vs 1.4%, P < .001; 7% vs 4.8%, P = .02, respectively). High NLR (>6.97) was found as an independent predictor of inhospital cardiovascular mortality (odds ratio: 2.8, 95% confidence interval: 1.37-5.74, P = .005). CONCLUSIONS High NLR level is associated with increased inhospital and long-term cardiovascular mortality in patients with STEMI undergoing primary angioplasty.
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Affiliation(s)
- Mehmet Ergelen
- 1Department of Cardiology, Bezmialem Vakıf University, School of Medicine, Istanbul, Turkey
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Kaya MG, Akpek M, Lam YY, Yarlioglues M, Celik T, Gunebakmaz O, Duran M, Ulucan S, Keser A, Oguzhan A, Gibson MC. Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention: a prospective, multicenter study. Int J Cardiol 2012; 168:1154-9. [PMID: 23219132 DOI: 10.1016/j.ijcard.2012.11.074] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 11/11/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The pre-procedural neutrophil to lymphocyte ratio (N/L) is associated with adverse outcomes among patients with coronary artery disease but its prognostic value in ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. This study evaluated the relations between pre-procedural N/L ratio and the in-hospital and long-term outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHODS A total of 682 STEMI patients presented within the first 6h of symptom onset were enrolled and stratified according to tertiles of N/L ratio based on the blood samples obtained in the emergency room upon admission. RESULTS The mean follow-up period was 43.3 months (1-131 months). In-hospital in-stent thrombosis, non-fatal myocardial infarction, and cardiovascular mortality increased as the N/L tertile ratio increased (p<0.001, p<0.001, p=0.003, respectively). Long-term in-stent thrombosis, non-fatal myocardial infarction and cardiovascular mortality also increased as the N/L ratio increased (p<0.001, p<0.001, p=0.002, respectively). On multivariate analysis, N/L ratio remained an independent predictor for both in-hospital (OR 1.189, 95% CI 1.000-1.339; p<0.001) and long-term major (OR 1.228, 95% CI 1.136-1.328; p<0.001) adverse cardiac events. CONCLUSION The N/L ratio was an independent predictor of both in-hospital and long-term adverse outcomes among STEMI patients undergoing primary PCI. Our findings suggest that this inexpensive, universally available hematological marker may be incorporated into the current established risk assessment model for STEMI.
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Affiliation(s)
- Mehmet G Kaya
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
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Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, Shevach A, Berliner S, Herz I, Keren G, Banai S. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 2012; 225:456-60. [PMID: 23040448 DOI: 10.1016/j.atherosclerosis.2012.09.009] [Citation(s) in RCA: 223] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 09/08/2012] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND 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. OBJECTIVE 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. MATERIALS AND METHODS 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. RESULTS The cohort was divided into 3 groups according to the NLR value (<2, 2-3, and >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). CONCLUSION 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.
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Affiliation(s)
- Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
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Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, Ergin A, Gibson CM. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2012; 110:621-7. [PMID: 22608360 DOI: 10.1016/j.amjcard.2012.04.041] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/26/2012] [Accepted: 04/26/2012] [Indexed: 11/25/2022]
Abstract
With the growing understanding of the role of inflammation in patients with atherosclerotic disease, studies have focused on high-sensitivity C-reactive protein (hs-CRP) and other inflammatory markers in their association with outcomes in ST-segment elevation myocardial infarction. The goal of this study was to investigate the association of the neutrophil/lymphocyte (N/L) ratio and in-hospital major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). The association of hs-CRP and N/L ratio on admission with Thrombolysis In Myocardial Infarction (TIMI) flow grade after PCI was assessed in 418 consecutive primary patients with PCI. The N/L ratio was significantly higher in the no-reflow group (TIMI grade 0/1/2 flow, n = 158) compared to that of the normal-flow group (TIMI grade 3 flow, n = 260, 4.6 ± 1.7 vs 3.1 ± 1.9, p <0.001). In-hospital MACEs were significantly higher in patients with no reflow (23% vs 7%, p <0.001). There was a significant and positive correlation between hs-CRP and N/L ratio (r = 0.657, p <0.001). In receiver operating characteristic analysis, N/L ratio >3.3 predicted no reflow with 74% sensitivity and 83% specificity. In a multivariate regression model, N/L ratio remained an independent correlate of no reflow (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.34 to 1.76, p <0.001) and in-hospital MACEs (OR 1.14, 95% CI 0.98 to 1.32, p = 0.043). The N/L ratio, an inexpensive and easily measurable laboratory variable, is independently associated with the development of no reflow and in-hospital MACEs in patients with ST-segment elevation myocardial infarction undergoing primary PCI.
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Gao XM, White DA, Dart AM, Du XJ. Post-infarct cardiac rupture: Recent insights on pathogenesis and therapeutic interventions. Pharmacol Ther 2012; 134:156-79. [DOI: 10.1016/j.pharmthera.2011.12.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 01/15/2023]
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Swiatkiewicz I, Kozinski M, Magielski P, Gierach J, Fabiszak T, Kubica A, Sukiennik A, Navarese EP, Odrowaz-Sypniewska G, Kubica J. Usefulness of C-reactive protein as a marker of early post-infarct left ventricular systolic dysfunction. Inflamm Res 2012; 61:725-34. [PMID: 22446726 PMCID: PMC3375005 DOI: 10.1007/s00011-012-0466-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 02/28/2012] [Accepted: 03/08/2012] [Indexed: 01/20/2023] Open
Abstract
Objective To assess the usefulness of in-hospital measurement of C-reactive protein (CRP) concentration in comparison to well-established risk factors as a marker of post-infarct left ventricular systolic dysfunction (LVSD) at discharge. Materials and methods Two hundred and four consecutive patients with ST-segment-elevation myocardial infarction (STEMI) were prospectively enrolled into the study. CRP plasma concentrations were measured before reperfusion, 24 h after admission and at discharge with an ultra-sensitive latex immunoassay. Results CRP concentration increased significantly during the first 24 h of hospitalization (2.4 ± 1.9 vs. 15.7 ± 17.0 mg/L; p < 0.001) and persisted elevated at discharge (14.7 ± 14.7 mg/L), mainly in 57 patients with LVSD (2.4 ± 1.8 vs. 25.0 ± 23.4 mg/L; p < 0.001; CRP at discharge 21.9 ± 18.6 mg/L). The prevalence of LVSD was significantly increased across increasing tertiles of CRP concentration both at 24 h after admission (13.2 vs. 19.1 vs. 51.5 %; p < 0.0001) and at discharge (14.7 vs. 23.5 vs. 45.6 %; p < 0.0001). Multivariate analysis demonstrated CRP concentration at discharge to be an independent marker of early LVSD (odds ratio of 1.38 for a 10 mg/L increase, 95 % confidence interval 1.01–1.87; p < 0.04). Conclusion Measurement of CRP plasma concentration at discharge may be useful as a marker of early LVSD in patients after a first STEMI.
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Affiliation(s)
- Iwona Swiatkiewicz
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland.
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Bian C, Wu Y, Shi Y, Xu G, Wang J, Xiang M, Weng S, Jiang J, Ma J. Predictive value of the relative lymphocyte count in coronary heart disease. Heart Vessels 2010; 25:469-73. [DOI: 10.1007/s00380-010-0010-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 12/17/2009] [Indexed: 10/19/2022]
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Total lymphocyte count and in-hospital mortality in older persons with multimorbidity. Aging Clin Exp Res 2008; 20:290-6. [PMID: 18852540 DOI: 10.1007/bf03324858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Low total lymphocyte count (TLC) has been found to be a poor prognostic factor in adults affected by heart diseases, malignancy, and renal failure. The aims of this study were to verify if a low TLC was associated with in-hospital mortality in older persons and to evaluate whether this association was independent of the presence of multiple co-existing diseases (multimorbidity). METHODS The authors carried out a cross-section analysis of data of 65+ years old patients (n=596) admitted to a Geriatric Unit in Northern Italy. TLC, total white blood cell count (WBC) and serum albumin were assayed the day after admission. The presence and severity of diseases were evaluated with the Geriatric Index of Comorbidity (GIC). Other covariates included age, gender, cigarette smoking, cognition (Mini-Mental State Examination) and function (Activities of Daily Living). Logistic regression models were created to study factors affecting in-hospital death. RESULTS TLC was inversely correlated with both age and multimorbidity. Patients in the lowest tertile of TLC had the highest association with death during hospitalization (OR 6.1, 95% CI 1.1-33.6) independently of multimorbidity and all the other covariates. Stratifying the sample by degree of multimorbidity, this association was clearest in patients with the least severe multimorbidity (GIC <or=3). CONCLUSIONS Although TLC and multimorbidity were correlated, they emerged as independent predictors of in-hospital death. Further investigations into possible biological mechanisms underlying the association of lymphocytes and adverse outcomes in old persons are needed.
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Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008; 101:747-52. [PMID: 18328833 DOI: 10.1016/j.amjcard.2007.11.004] [Citation(s) in RCA: 333] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 11/04/2007] [Accepted: 11/04/2007] [Indexed: 01/14/2023]
Abstract
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.
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Rudiger A, Burckhardt OA, Harpes P, Müller SA, Follath F. The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med 2006; 24:451-4. [PMID: 16787804 DOI: 10.1016/j.ajem.2005.10.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Revised: 10/07/2005] [Accepted: 10/09/2005] [Indexed: 11/28/2022] Open
Affiliation(s)
- Alain Rudiger
- Bloomsbury Institute of Intensive Care Medicine, Wolfson Institute of Biomedical Research, University College London, WC1E 6BT London, UK, and Department of Internal Medicine, University Hospital Zurich, Switzerland.
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Brunschwig T, Eberli FR, Herren T. [Mechanical complications of acute myocardial infarction]. ZEITSCHRIFT FUR KARDIOLOGIE 2004; 93:897-907. [PMID: 15568150 DOI: 10.1007/s00392-004-0133-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Accepted: 06/21/2004] [Indexed: 05/01/2023]
Abstract
Rupture of the left ventricular myocardium during the course of an acute myocardial infarction may affect the free wall, the interventricular septum, or the papillary muscles. When a rupture occurs, it is referred to as a mechanical complication of acute myocardial infarction. All mechanical complications may lead to cardiogenic shock. However, the location of the rupture can often be suspected clinically. To confirm the diagnosis, echocardiography must be performed. Since the advent of thrombolytic therapy and percutaneous coronary intervention, the incidence of mechanical complications has declined. Even though mortality remains high, their recognition is important since survivors may have an excellent long-term prognosis. The cases convey two main messages: 1) Mechanical complications must be carefully searched for in any patient with an acute coronary syndrome and signs of cardiogenic shock and/or a systolic murmur. 2) Aggressive and timely medical and surgical treatment should be provided even though in a substantial proportion of these patients prognosis may be dismal.
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Affiliation(s)
- T Brunschwig
- Medizinische Klinik, Spital Limmattal, Urdorferstrasse 100, 8952 Schlieren, Schweiz
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