Neutrophil count as the centerpiece in the joined association networks of inflammatory and cell damage markers, and neuroendocrine stress markers in patients with stable angina pectoris following stenting

Prognostic impact of monocyte-to-lymphocyte ratio in coronary heart disease: a systematic review and meta-analysis

OBJECTIVE

Inflammatory biomarkers are novel tools to assess the prognosis of different cardiovascular diseases. We evaluated the impact of the monocyte-to-lymphocyte ratio (MLR) on clinical outcomes in patients with coronary heart disease (CHD).

METHODS

We systematically screened English-language articles in PubMed, Scopus, and Web of Science to 31 August 2022. Relevant articles reporting the MLR and its association with clinical outcomes (major adverse cardiovascular events (MACE), coronary artery disease (CAD) severity, mortality, cardiac rupture, subclinical CAD, acute coronary syndrome (ACS) prediction, thin-cap fibroatheroma, no-reflow phenomenon, MLR-related differences in percutaneous coronary intervention, heart failure hospitalization, and depression) in patients with CHD were collected for further analysis.

RESULTS

Nineteen articles were selected. The mean MLR was 0.34. A higher MLR was significantly associated with an increased risk of MACE among patients with CHD. The MLR was an independent predictor of MACE in patients with ACS. No significant association was found for CAD severity. A complementary analysis was not performed because of few studies focusing on the other predefined endpoints.

CONCLUSIONS

The MLR is a simple and widely available tool to predict MACE in patients with CHD. This biomarker can be utilized in emergency settings to prioritize high-risk patients and optimize therapeutic interventions.

The prognostic value of neutrophil-to-lymphocyte ratio across all stages of coronary artery disease

The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor long-term outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.

Sex Difference in the Association Between Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease

The neutrophil to lymphocyte ratio (NLR) is a predictor of cardiovascular risk. However, little was known about the influence of sex in this relationship. The present study was designed to evaluate the association between NLR and coronary artery disease (CAD) risk and severity in males and females. A total of 810 patients (478 males and 332 females) who had undergone coronary angiography at the Beijing Chaoyang Hospital were enrolled. CAD severity was evaluated using the Gensini and SYNTAX scores. For males, the NLR was higher in CAD patients than that in non-CAD patients (all P < .001). But there was no significant difference in NLR between female CAD and non-CAD patients (P = .222). The NLR correlated with the Gensini and SYNTAX scores in male CAD patients (both P < .001), but this correlation was not found in female counterparts (both P > .10). Logistic regression analyses and receiver operator characteristic curve (ROC) analyses showed that the NLR was an independent risk factor and a predictor of CAD in males (both P < .01) but not in females (both P > .10). In conclusion, the NLR was closely related to the presence and severity of CAD in males but not in females.

Blood Routine Test Parameters Score, a Novel Predictor of Adverse Outcomes of Coronary Artery Disease Patients with or without Diabetes Who Underwent Percutaneous Coronary Intervention: A Retrospective Cohort Study

BACKGROUND

In this study, we developed a novel risk score named the blood routine test parameters (BRTP) score to predict the clinical outcomes in coronary artery disease (CAD) patients who had undergone percutaneous coronary intervention (PCI).

METHODS

There were 6049 patients with CAD after PCI enrolled in CORFCHD-PCI from January 2008 to December 2016. We divided these patients into two groups according to diabetes (diabetic group, n = 3809, and nondiabetic group, n = 2240). During a follow-up time of 35.9 ± 22.6 months, we compared the incidences of all-cause mortality (ACM) and cardiac mortality (CM), which were assigned as the primary outcomes between patients with a high BRTP score (≥5 points) and those with a low BRTP score (<5 points).

RESULTS

We found that the BRTP score independently predicted the risk for ACM and CM in both diabetic patients [ACM, hazard risk (HR) = 1.748 (95% confidence interval (CI): 1.186-2.575), P = 0.005; CM, HR = 1.728 (95% CI: 1.120-2.667), P = 0.014] and nondiabetic patients [ACM, HR = 1.682 (95% CI: 1.208-2.340), P = 0.002; CM, HR = 1.718 (95% CI: 1.188-2.484), P = 0.004]. However, the BRTP score was found to be an independent predictor for major adverse cardiovascular event (MACE) and major adverse cardiovascular and cerebrovascular event (MACCE) in diabetic patients [MACE, HR = 1.366 (95% CI: 1.076-1.734), P = 0.010; MACCE, HR = 1.330 (95% CI: 1.035-1.710), P = 0.026] but not in nondiabetic patients [MACE, HR = 1.241 (95% CI: 0.994-1.549), P = 0.056; MACCE, HR = 1.238 (95% CI: 0.981-1.562), P = 0.072].

CONCLUSIONS

This study suggests that the BRTP score is an independent and novel predictor of mortality in CAD patients who had undergone PCI, especially in patients with comorbidity of diabetes.

TRIAL REGISTRATION

ChiCTR-ROC-16010153. Registered 14, December, 2016.

Association of neutrophil to lymphocyte ratio (NLR) with angiographic SYNTAX score in patients with non-ST-Segment elevation acute coronary syndrome (NSTE-ACS)

Introduction: Considering the role of inflammation in pathogenesis of atherosclerosis, we aimed to investigate the association of presentation neutrophil to lymphocyte ratio (NLR) with complexity of coronary artery lesions determined by SYNTAX score in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods: From March 2018 to March 2019, we recruited 202 consecutive patients, who were hospitalized for NSTE-ACS and had undergone percutaneous coronary intervention in our hospital. The association of presentation NLR with SYNTAX score was determined in univariate and multivariate linear regression analysis. Results: Higher NLR was significantly associated with higher SYNTAX score (beta = 0.162, P = 0.021). In addition, older age, having hypertension, higher TIMI score, and lower ejection fraction on echocardiographic examination were significantly associated with higher SYNTAX score. TIMI score had the largest beta coefficient among the studied variables (TIMI score beta = 0.302, P < 0.001). In two separate multivariate linear regression models, we assessed the unique contribution of NLR in predicting SYNTAX score in patients with NSTE-ACS. In the first model, NLR was significantly contributed to predicting SYNTAX score after adjustment for age, sex, and hypertension as covariates available on patient presentation (beta = 0.142, P = 0.040). In the second model, NLR was not an independent predictor of SYNTAX score after adjustment for TIMI score (beta = 0.121, P = 0.076). Conclusion: In NSTE-ACS, presentation NLR is associated with SYNTAX score. However, NLR does not contribute significantly to the prediction of SYNTAX score after adjustment for TIMI score. TIMI risk score might be a better predictor of the SYNTAX score in comparison to NLR.