Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention

Predictive value of inflammation-based Glasgow prognostic score, platelet-lymphocyte ratio, and global registry of acute coronary events score for major cardiovascular and cerebrovascular events during hospitalization in patients with acute myocardial infarction

Purpose: The goal of this study was to evaluate the predictive ability of the inflammation-based Glasgow Prognostic Score (GPS), platelet-lymphocyte ratio (PLR), Global Registry of Acute Coronary Events (GRACE) score and combined diagnostic models for the occurrence of major adverse cardiovascular and cerebrovascular events (MACEs) in patients with acute myocardial infarction (AMI).

Methods: In this retrospective cohort study, eligible patients were required to meet the third global definition of myocardial infarction. The primary outcome of this study was the occurrence of MACEs during hospitalization. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive ability of the GPS, PLR, GRACE scores, and joint diagnostic models for primary outcomes; univariate and multivariate logistic regression analyses were performed.

Findings: A total of 175 patients were enrolled. The results of the univariate ROC curve analysis for the incidence of MACEs during hospitalization showed that the area under the curve (AUC) was 0.780 (95% confidence interval (CI) 0.696-0.864) for the GPS, 0.766 (95% CI 0.682-0.850) for the redefined GPS (RGPS), 0.561 (95% CI 0.458-0.664) for the PLR score (PLRS), and 0.793 (95% CI 0.706-0.880) for GRACE. Multivariate ROC curve analysis showed that the AUC value was 0.809 (95% CI 0.726-0.893) for the GPS combined with GRACE, 0.783 (95% CI 0.701-0.864) for the GPS combined with the PLRS, 0.794 (95% CI 0.707-0.880) for GRACE combined with the PLRS, and 0.841 (95% CI 0.761-0.921) for the GPS combined with GRACE and the PLRS. The combined diagnostic model including the GPS plus GRACE and the PLRS had a higher AUC value than the GPS, RGPS and GRACE models (P = 0.014, P = 0.004, and P = 0.038, respectively). The multivariate logistic regression model showed that the odds ratio for hospitalized MACEs was 5.573 (95% CI 1.588-19.554) for GPS scores of 2 versus 0, and the GRACE score was also an independent risk factor for MACEs, with an odds ratio of 1.023 (95% CI 1.009-1.036). Implications: The diagnostic model combining the GPS plus GRACE and the PLRS has better predictive ability for the occurrence of MACEs during hospitalization than each single score. Thus, the use of a combined GPS plus GRACE and PLRS model will be of clinical benefit in a broad group of individuals with AMI.

A Novel Index for Prompt Prediction of Severity in Patients with Unstable Angina Pectoris

Objectives

Rapid risk stratification by emergency department (ED) physicians to evaluate patients with chest pain for predicting the short-term occurrence of major adverse cardiac event (MACE) is crucial. The aim of this study was to investigate the predictive value of platelet-lymphocyte ratio (PLR) levels and compare with the modified heart score (m-HS) and stress testing to predict the severity of high-risk patients with unstable angina pectoris (UAP) in the ED.

Methods

This study is prospective which included 316 patients with UAP and 316 control healthy subjects. The study took place from 01 April 2016, until 01 April 2017, in Medipol University.

Result

The mean PLR levels in the UAP group were higher than those in the control group (p < 0.001). The mean PLR of the m-HS ≥4 group was higher than that in the m-HS ≤3 group (p < 0.001). The mean levels of PLR in the subgroups based on the stress testing positivity were higher than those in the stress testing negative subgroup (p < 0.001). PLR levels were positively correlated with the m-HS, stress testing, and treatment decision in this study (r = 0.559; p < 0.001; r = 0.582; p < 0.001; r = 0.789; p < 0.001, respectively).

Conclusion

A positive correlation was determined with an increase in m-HS, treatment decision, and positive exercise testing as the PLR levels increased, indicating the severity of high risk of UAP in the ED.

Association of platelet-to-lymphocyte count ratio with myocardial reperfusion and major adverse events in patients with acute myocardial infarction: a two-centre retrospective cohort study

OBJECTIVE

Insufficient myocardial reperfusion for patients with acute myocardial infarction (AMI) during primary percutaneous coronary intervention (PPCI) has a great influence on prognosis. The aim of this study was to investigate the association of the platelet-to-lymphocyte ratio (PLR) with myocardial reperfusion and in-hospital major adverse cardiac events (MACEs) in patients with AMI undergoing PPCI.

DESIGN

Retrospective cohort study.

SETTING

Patients and researchers from two tertiary hospitals.

PARTICIPANTS

A total of 445 consecutive AMI patients who underwent PPCI between January 2015 and December 2017 were enrolled. Patients were divided into two groups based on the PLR value: patients with PLR values in the third tertile were defined as the high-PLR group (n=150), and those in the lower two tertiles were defined as the low-PLR group (n=295). Explicit criteria for inclusion and exclusion were applied.

INTERVENTIONS

No interventions.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures were defined as cardiovascular death, reinfarction or target vessel revascularisation. Secondary outcome measures were defined as stroke, non-lethal myocardial infarction, ventricular tachycardia/ventricular fibrillation and in-hospital mortality.

RESULTS

The high-PLR group had insufficient myocardial perfusion (23% vs 13%, p=0.003), greater postprocedural thrombolysis in myocardial infarction flow grade (0-2) (17% vs 10%, p=0.037), greater myocardial blush grade (0-1) (11% vs 4%, p=0.007) and higher B-type natriuretic peptide (BNP) (614±600 vs 316±429, p<0.001) compared with the low-PLR group. Multivariate logistic regression analysis indicated that the independent risk factors for impaired myocardial perfusion were high PLR (OR 1.256, 95% CI 1.003 to 1.579, p=0.056) and high BNP (OR 1.328, 95% CI 1.056 to 1.670, p=0.015). The high-PLR group had significantly more MACEs (43% vs 32%, p=0.029).

CONCLUSIONS

This study suggested that high PLR and BNP were independent risk factors for insufficient myocardial reperfusion in patients with AMI. Higher PLR was related to advanced heart failure and in-hospital MACEs in patients with AMI undergoing PPCI.

Platelet to lymphocyte ratio predicts all-cause mortality in patients with carotid arterial disease

BACKGROUND

Platelet to lymphocyte ratio (PLR) has been demonstrated as a risk and prognostic marker in many of cardiovascular diseases. A relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease.

METHODS

This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of platelets to lymphocytes. The end point of the study was all-cause mortality.

RESULTS

During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients (34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7 ± 1.6 g/dL vs. 13.7 ± 1.7 g/dL, p = 0.031) and they were older than survivors (74.2 ± 8.4 years vs. 68.6 ± 8.5 years, p = 0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3 ± 85.6 and 126.8 ± 53.8, p = 0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis.

CONCLUSION

In our study, higher PLR was associated with increased all-cause mortality.