The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention

MELD-XI score predict no-reflow phenomenon and short-term mortality in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

INTRODUCTION

No-reflow phenomenon (NRP) is one of the complications that mostly occur during percutaneous coronary intervention (PCI). In this study, we comprehensively examined the relationship between the model for end-stage liver disease-XI (MELD-XI) score and NRP. Moreover, we discussed whether the MELD-XI score could be considered as an accurate risk assessment score of patients with ST-segment elevation myocardial infarction (STEMI) who are candidates for PCI.

METHODS

This retrospective study involved 693 patients with acute STEMI and who underwent an emergency PCI. They were divided into a normal reflow group or a no-reflow group on the basis of the flow rate of post-interventional thrombolysis in myocardial infarction. Univariate, multivariate logistic regression, and Cox regression analyses were performed to identify the independent predictors of NRP in both groups. Receiver operator characteristic (ROC) curves and Kaplan-Meier curves were plotted to estimate the predictive values of the MELD-XI score.

RESULTS

MELD-XI score was found to be an independent indicator of NRP (odds ratio: 1.247, 95% CI: 1.144-1.360, P < 0.001). Multivariate Cox regression analysis also revealed that the MELD-XI score is an independent prognostic factor for 30-day all-cause mortality (hazard ratio: 1.155, 95% CI: 1.077-1.239, P < 0.001). Moreover, according to the ROC curves, the cutoff value of the MELD-XI score to predict NRP was 9.47 (area under ROC curve: 0.739, P < 0.001). The Kaplan-Meier curves for 30-day all-cause mortality revealed lower survival rate in the group with a MELD-XI score of > 9.78 (P < 0.001).

CONCLUSION

The MELD-XI score can be used to predict NRP and the 30-day prognosis in patients with STEMI who are candidates for primary PCI. It could be adopted as an inexpensive and a readily available tool for risk stratification.

Determination of risk factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention

BACKGROUND

To determine the factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish its prognostic discriminant model.

METHODS

A total of 701 consecutive STEMI patients undergoing PCI were enrolled in this study. The patients were divided into two groups, good prognosis and poor prognosis, based on whether the patient had adverse outcomes (death or heart function ≥ grade III) at discharge. Demographic and basic clinical characteristics, diagnosis at admission (e.g., ventricular function, complications, or hyperlipidemia), and biomedical indicators (e.g., blood count, basal metabolism and biochemical composition, blood lipid and glucose levels, myocardial biomarkers, and coagulation) were collected and analyzed.

RESULTS

We determined 22 factors as risk factors for the in-hospital prognosis of STEMI patients after PCI: age, cardiac function during hospitalization, complications, history of diabetes mellitus, et al., among which the history of diabetes, uric acid, urea nitrogen, and activated partial thromboplastin time (APTT) were independent risk factors.

CONCLUSION

We identified four independent risk factors for the in-hospital prognosis of STEMI patients after PCI and generated a prognostic model to predict the adverse outcomes of these patients.

hsCRP and ET-1 expressions in patients with no-reflow phenomenon after Percutaneous Coronary Intervention

Objective:

To explore hsCRP and ET-1 expressions in patients with no-reflow phenomenon after percutaneous coronary intervention (PCI).

Methods:

A total of 136 patients with single coronary artery disease receiving PCI were divided into a reflow group and a no-reflow group to compare the level use of ET-1 alone with combined level of ET-1 and hs-CRP in PCI regarding sensitivity, specificity, positive and negative predictive values and accuracy for postoperative no-reflow. The study was conducted between 2014-2016 at our hospital.

Results:

Postoperative levels of ET-1 and hs-CRP in no-reflow group were significantly higher than those of reflow group (P<0.05). ET-1 level of reflow group peaked three hours after PCI and then declined. Serum level of hs-CRP decreased most obviously within three hours after PCI in reflow group and three hours - three days after PCI in no-reflow group. Left ventricular end-diastolic diameters of both groups after PCI were apparently lower than those before PCI, without significant inter-group difference (P>0.05). Left ventricular end-systolic diameters and left ventricular ejection fractions of both groups evidently increased after PCI, without significant inter-group differences either (P>0.05). Corrected TIMI frame count (CTFC) and wall motion score index of reflow group after PCI were significantly lower than those of no-reflow group (P<0.05). ET-1 level was positively correlated with CTFC (P<0.05). Multivariate linear regression showed hs-CRP was negatively correlated with the serum level (P<0.05) (r=-0.34).

Conclusion:

hsCRP and ET-1 levels significantly increased in patients with no-reflow phenomenon.

Prognostic Value of Circulating Inflammatory Cells in Patients with Stable and Acute Coronary Artery Disease

Atherosclerosis is a lipid driven chronic inflammatory disease underlying the majority of ischemic events such as myocardial infarction or stroke. Clinical management of ischemic events has improved considerably in the past decades. Accordingly, survival rates have increased. Nevertheless, 12% of patients die within 6 months after the initial event. To improve secondary prevention, appropriate risk prediction is key. However, up to date, there is no clinically available routine marker to identify patients at high risk for recurrent cardiovascular events. Due to the central role of inflammation in atherosclerotic lesion progression and destabilization, many studies have focused on the role of circulating inflammatory cells in these processes. This review summarizes the current evidence on the potential of circulating inflammatory cells as biomarkers for recurrent adverse manifestations in acute coronary syndrome and stable coronary artery disease patients.

Clinic Predictive Factors for Insufficient Myocardial Reperfusion in ST-Segment Elevation Myocardial Infarction Patients Treated with Selective Aspiration Thrombectomy during Primary Percutaneous Coronary Intervention

Background. Insufficient data are available on the potential benefit of selective aspiration and clinical predictors for no-reflow in STEMI patients undergoing primary percutaneous coronary intervention (PPCI) adjunct with aspiration thrombectomy. Objective. The aim of our study was to investigate clinical predictors for insufficient reperfusion in patients with high thrombus burden treated with PPCI and manual aspiration thrombectomy. Methods. From January 2011 till December 2015, 277 STEMI patients undergoing manual aspiration thrombectomy and PPCI were selected and 202 patients with a Thrombolysis in Myocardial Infarction (TIMI) thrombus grade 4~5 were eventually involved in our study. According to a cTFC value, patients were divided into Group I (cTFC > 40), namely, insufficient reperfusion group; Group II (cTFC ≤ 40), namely, sufficient reperfusion group. Results. Univariate analysis showed that hypertension, multivessel disease, time from symptom to PCI (≧4.8 hours), and postaspiration cTFC > 40 were negative predictors for insufficient reperfusion. After multivariate adjustment, age ≧ 60 years, hypertension, time from symptom to PCI (≧4.8 hours), and postaspiration cTFC > 40 were independently associated with insufficient reperfusion in STEMI patients treated with manual aspiration thrombectomy. Upfront intracoronary GP IIb/IIIa inhibitor (Tirofiban) was positively associated with improved myocardial reperfusion. Conclusion. Fully identifying risk factors will help to improve the effectiveness of selective thrombus aspiration.

Impact of neutrophil-to-lymphocyte ratio on periprocedural myocardial infarction in patients undergoing non-urgent percutaneous coronary revascularisation

BACKGROUND

Pro-thrombotic conditions importantly influence myocardial perfusion and procedural results after percutaneous coronary intervention (PCI). The neutrophil-to-lymphocyte ratio (NLR) has emerged as a predictor of cardiovascular events and of long-term prognosis, especially in ST-elevation myocardial infarction patients undergoing primary PCI. The aim of our study was to evaluate the role of NLR on periprocedural myocardial infarction (MI) in patients undergoing non-urgent PCI.

METHODS

In a consecutive cohort of 1542 patients undergoing PCI, myonecrosis biomarkers were determined at 6, 12, 24 and 48 hours post-procedure. Patients were divided into quintiles according to NLR values. Periprocedural myonecrosis was defined as a troponin I increase of 3 times the upper limit of normal or as 50 % of an elevated baseline value, whereas periprocedural MI was defined as a CK-MB increase of 3 times the upper limit of normal or 50 % of baseline.

RESULTS

Higher NLR was related to age, established risk factors and cardiovascular history. NLR was associated with severe coronary artery disease (p = 0.009), tighter stenosis (p < 0.001), coronary calcifications (p = 0.005), intracoronary thrombus or thrombectomy use (p < 0.001), TIMI flow pre- and post-PCI (p < 0.001), and inversely to restenosis (p = 0.04) and use of a drug-eluting stent (p = 0.001). NLR did not influence the occurrence of myonecrosis (p = 0.75; adjusted OR (95 % CI) = 0.99 (0.63-1.54), p = 0.96), but was associated with a higher occurrence of periprocedural MI, even after correction for baseline differences (p = 0.03; adjusted OR (95 % CI) = 1.33 (1.02-2.3), p = 0.02), with NLR ≥ 3 best predicting the risk of periprocedural MI at the receiver operating characteristic curve analysis.

CONCLUSION

In patients undergoing non-urgent PCI, a higher NLR increases the risk of periprocedural MI, especially for values ≥ 3.

Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism

INTRODUCTION

Neutrophil-to-lymphocyte ratio (NLR), which is an essential marker of inflammation, has been shown to be associated with adverse outcomes in various cardiovascular diseases in the literature. In this study we sought to evaluate the association between NLR and prognosis of acute pulmonary embolism (APE).

MATERIAL AND METHODS

We retrospectively evaluated blood counts and clinical data of 142 patients with the diagnosis of pulmonary embolism (PE) from Ondokuz Mayis University Hospital between January 2006 and December 2012. The patients were divided into two groups according to NLR: NLR < 4.4 (low NLR group, n = 71) and NLR ≥ 4.4 (high NLR group, n = 71).

RESULTS

Massive embolism (66.2% vs. 36.6%, p < 0.001) and in-hospital mortality (21.1%, 1.4%, p < 0.001) were higher in the high NLR group. In multivariate regression analysis NLR ≥ 5.7, systolic blood pressure (BP) < 90 mm Hg, serum glucose > 126 mg/dl, heart rate > 110 beats/min, and PCO2 < 35 or > 50 mm Hg were predictors of in-hospital mortality. The optimal NLR cutoff value was 5.7 for mortality in receiver operating characteristic (ROC) analysis. Having an NLR value above 5.7 was found to be associated with a 10.8 times higher mortality rate than an NLR value below 5.7.

CONCLUSIONS

In patients presenting with APE, NLR value is an independent predictor of in-hospital mortality and may be used for clinical risk classification.

Association of high density lipoprotein with platelet to lymphocyte and neutrophil to lymphocyte ratios in coronary artery disease patients

Background. We aimed to evaluate a relationship between platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) with high density lipoprotein (HDL) cholesterol levels in coronary artery disease (CAD) patients. Methods. A total of 354 patients with angiographically confirmed coronary blockages were enrolled in the study. Hematological indices and lipid profiling data of all the patients were collected. Results. We have observed significant association between HDL and PLR (P = 0.008) and NLR (P = 0.009); however no significant relationship was obtained with HDL and isolated platelet (P = 0.488), neutrophil (P = 0.407), and lymphocyte (P = 0.952) counts in CAD patients. The association was subjected to gender specific variation as in males PLR (P = 0.024) and NLR (P = 0.03) were highly elevated in low HDL patients, whereas in females the elevation could not reach the statistically significant level. The PLR (217.47 versus 190.3; P = 0.01) and NLR (6.33 versus 5.10; P = 0.01) were significantly higher among the patients with acute coronary syndrome. In young patients the PLR (P = 0.007) and NLR (P = 0.001) were inversely associated with HDL, whereas in older population only NLR (P = 0.05) had showed a significant association. Conclusion. We conclude that PLR and NLR are significantly elevated in CAD patients having low HDL levels.

Association Between Hematological Indices and Coronary Calcification in Symptomatic Patients without History of Coronary Artery Disease

Background:

Atherosclerotic coronary artery disease (CAD) has long been shown to involve chronic low-grade subclinical inflammation. However, whether there is association between hematological indices assessed by complete blood count (CBC) and coronary atherosclerotic burden has not been well studied.

Materials and Methods:

Consecutive 868 patients without known CAD who presented with acute chest pain to emergency department and underwent coronary artery calcium (CAC) scoring evaluation by multi-detector cardiac computed tomography were included in our study. Clinical characteristics and CBC indices were compared among different CAC groups.

Results:

The cohort comprised 60% male with a mean age of 61 (SD = 14) years. Median Framingham risk of CAD was 4% (range 1-16%). Median CAC score was 0 (IQR 0-43). Higher CAC groups had significantly higher Framingham risk of CAD than lower CAC groups (P < 0.001). Among different CAC categories, there was no statistically significant difference in hemoglobin level (p 0.45), mean corpuscular volume (p 0.43), mean corpuscular hemoglobin (p 0.28), mean corpuscular hemoglobin volume (p 0.36), red cell distribution width (0.42), total white blood cell counts (p 0.291), neutrophil counts (p 0.352), lymphocyte counts (p 0.92), neutrophil to lymphocyte ratio (p 0.68), monocyte count (p 0.48), and platelet counts (p 0.25).

Conclusion:

Our study did not detect significant association between hematological indices assessed with CBC and coronary calcification in symptomatic patients without known CAD.

Neutrophil-to-lymphocyte ratio (NLR) predicts mortality and adverse-outcomes after ST-segment elevation myocardial infarction in Chinese people

Neutrophil-to-lymphocyte ratio (NLR) has been reported to predict cardiovascular risks and mortality in coronary artery diseases. We aimed to evaluate the capacity of NLR to predict long-term mortality in Chinese patients presenting with ST-segment elevation myocardial infarction (STEMI). We recorded NLR at admission, 24 or 72 hours after admission, and at discharge (14±2 days) of 692 patients presenting with STEMI at Xuanwu hospital, Beijing between 2002 and 2005, and assessed the capacity of NLR to predict mortality during follow up (median 9.43, interquartile range (IQR) 8.65-10.28 years). Backward stepwise multivariate Cox regression revealed that average inpatient NLR (NLRaverage) predicted all-cause mortality (Hazard ratio 1.481) more accurately than absolute leukocyte and neutrophil counts (P<0.001). When patients were stratified into tertiles by NLRaverage (T1 NLR<3.16, T3 NLR>4.75), patients in T3 exhibited a 4.621-fold higher risk of mortality than patients in T1 (P=0.002). Patients in T3 had a significantly higher incidence of all-cause mortality (10.00%) than T1 (2.17%) and T2 (4.31%), cardiac-mortality (8.70%) than T1 (2.17%) and T2 (4.31%), hypotension (20.00%) than T1 (5.65%) and T2 (12.93%), arrhythmia (43.91%) than T1 (24.14%) and T2 (24.35%), and defibrillation (7.83%) than T1 (1.74%) and T2 (5.17%) in hospital; and suffered from higher mortality (46.09%) than T1 (9.13%) and T2 (29.74%), cardiac mortality (27.83%) than T1 (5.22%) and T2 (15.52%) and MACE events (36.52%) than T1 (13.04%) and T2 (31.9%) during long-term follow-up. Average NLR was a useful and powerful predictor of mortality and adverse-outcomes in Chinese patients presenting with STEMI.