Korean Circ J.  2016 Jan;46(1):15-22. 10.4070/kcj.2016.46.1.15.

Neutrophil to Lymphocyte Ratio Predicts Left Ventricular Remodeling in Patients with ST Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention

• Borekci A
• Gur M
• Turkoglu C
• Baykan AO
• Seker T
• Sahin DY
• Harbalioglu H
• Elbasan Z
• Topuz M
• Cayli M

• KMID: 2223765
• DOI: http://doi.org/10.4070/kcj.2016.46.1.15

Abstract

BACKGROUND AND OBJECTIVES
It has been demonstrated that the neutrophil/lymphocyte ratio (NLR) might be a useful marker to predict cardiovascular risk and events. We aimed to investigate the role of the NLR to predict ventricular remodeling (VR) in patients with anterior ST-elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention.
SUBJECTS AND METHODS
We prospectively included 274 consecutive anterior STEMI patients. Echocardiography was performed during admission and at six months after myocardial infarction. VR was defined as at least 20% increase from baseline in left ventricular end-diastolic volume. Patients were divided into two groups according to their VR status: VR (n=67) and non-VR (n=207). Total and differential leukocyte count, N-terminal pro-brain natriuretic peptide (NT-proBNP) and other biochemical markers were measured at admission and 24 hours later.
RESULTS
Compared with the non-VR group, peak creatine kinase MB (CK-MB), NT-proBNP (24 h), neutrophil/lymphocyte ratio, presence of diabetes, no-reflow frequency and wall motion score index were significantly higher in patients with VR (p<0.05 for all). On multivariate logistic regression analysis, NLR (beta=2.000, 95% confidence interval=1.577-2.537, p<0.001) as well as peak CK-MB, NT-proBNP (24 h), WMSI and diabetes incidence were associated with VR. The cutoff value of the neutrophil/lymphocyte ratio obtained by receiver operator characteristic curve analysis was 4.25 for the prediction of VR (sensitivity: 79 %, specificity: 74%).
CONCLUSION
In patients with anterior STEMI, initial NLR and NT-proBNP measured 24 hours after admission may be useful for predicting adverse cardiovascular events including left VR.

Keyword

Myocardial infarction; Remodeling; Neutrophils, lymphocytes; BNP; No-reflow

MeSH Terms

Biomarkers
Creatine Kinase
Echocardiography
Humans
Incidence
Leukocyte Count
Logistic Models
Lymphocytes*
Myocardial Infarction*
Neutrophils*
Percutaneous Coronary Intervention*
Prospective Studies
Sensitivity and Specificity
Stroke Volume
Ventricular Remodeling*
Creatine Kinase

Figure

• 

  Fig. 1 The receiver operator characteristic (ROC) curve analysis of the neutrophil to lymphocyte ratio for predicting the presence of ventricular remodeling. NLR: neutrophil to lymphocyte ratio, AUC: area under the curve.

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