J Lipid Atheroscler.  2018 Jun;7(1):50-61. 10.12997/jla.2018.7.1.50.

Early Valuable Risk Stratification with Hemoglobin Level and Neutrophil to Lymphocyte Ratio in Patients with Non-ST-Elevation Myocardial Infarction Having an Early Invasive Strategy

• Jun SJ
• Jeong MH
• Cho KH
• Ahn Y
• Kim JH
• Cho JG
• Chae SC
• Kim YJ
• Seong IW
• Chae JK
• Kim HS
• for the KAMIR (Korea Acute Myocardial Infarction Registry)-NIH (Korea National Institute of Health) Investigators

• KMID: 2416258
• DOI: http://doi.org/10.12997/jla.2018.7.1.50

Abstract

OBJECTIVE
The complete blood count is the most widely available laboratory data in the early in-hospital period after acute myocardial infarction. We assessed the clinical utility of the combined use of hemoglobin (Hb) level and neutrophil to lymphocyte ratio (N/L) for early risk stratification in patients with non-ST-elevation myocardial infarction (STEMI).
METHODS
We analyzed 6,157 consecutive patients with non-STEMI (65±12.4 years, male 69%) were included in the final analysis. Patients were categorized into 3 groups by using the median value of N/L (4.42) and the presence of anemia (Hb <13 mg/dL in men and <12 mg/dL in women): group I, low N/L & no anemia (n=3,170); group II, no group I or III (n=2,168); group III, high N/L & anemia (n=819).
RESULTS
There were significant differences on clinical outcomes during 180-day follow-up among 3 groups. The prognostic discriminatory capacity of the combined use of Hb level and N/L was also significant in high-risk subgroups, such as patients with a renal dysfunction, multivessel coronary disease, low ejection fraction, and even in those having higher mortality risk based on the thrombolysis in myocardial infarction risk score. In a multi-variate logistic regression, after adjusting for multiple covariates, group III had higher incidence of major adverse cardiac events at 180-day (hazard ratio, 2.4; 95% confidence interval, 1.5-4.0;p≤0.001) compared with group I.
CONCLUSIONS
The combined use of Hb level and N/L provides valuable timely information for early risk stratification in patients with non-STEMI.

Keyword

Non-ST-elevated myocardial infarction; Blood cell count; Prognosis; Neutrophils; Lymphocytes

MeSH Terms

Anemia
Blood Cell Count
Coronary Disease
Follow-Up Studies
Humans
Incidence
Logistic Models
Lymphocytes*
Male
Mortality
Myocardial Infarction*
Neutrophils*
Prognosis

Figure

• 

  Fig. 1 Flow chart of the study population. KAMIR-NIH; Korea Acute Myocardial Infarction Registry-National Institute of Health, STEMI; ST-elevation myocardial infarction, N/L; neutrophil to lymphocyte ratio.

• 

  Fig. 2 Simple correlation analysis between age and (A) N/L (r=0.305; p<0.001) and (B) Hb level (r=−0.356; p<0.001). N/L; neutrophil to lymphocyte ratio, Hb; hemoglobin.

• 

  Fig. 3 (A) The 180-day mortality and (B) MACEs stratified by Hb level and N/L: no anemia & low N/L (n=3,170); no anemia & high N/L (n=1,134); anemia & low N/L (n=1,034); and anemia & high N/L (n=819). MACE; major adverse cardiac event, Hb; hemoglobin, N/L; neutrophil to lymphocyte ratio.

• 

  Fig. 4 The 180-day mortality according to (A) TIMI risk score and (B) GRACE score for non-STEMI in all patients (n=6,157). TIMI; thrombolysis in myocardial infarction, GRACE; Global Registry of Acute Coronary Events, STEMI; ST-elevation myocardial infarction.

• 

  Fig. 5 The 180-day MACEs according to (A) TIMI risk score and (B) GRACE score for non-STEMI in all patients (n=6,157). MACE; major adverse cardiac event, TIMI; thrombolysis in myocardial infarction, GRACE; Global Registry of Acute Coronary Events, STEMI; ST-elevation myocardial infarction.

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