Misumida Naoki, Kobayashi Akihiro, Saeed Madeeha, Fox John T, Kanei Yumiko
Department of Internal Medicine, Mount Sinai Beth Israel, NY, USA.
Department of Internal Medicine, Mount Sinai Beth Israel, NY, USA.
Cardiovasc Revasc Med. 2015 Sep;16(6):331-5. doi: 10.1016/j.carrev.2015.05.006. Epub 2015 May 21.
BACKGROUND/PURPOSE: Patients with acute coronary syndrome due to left main and/or three-vessel disease (LM/3VD) are at the highest risk of short- and long-term adverse cardiovascular events. Neutrophil-to-lymphocyte ratio (NLR) has been shown to predict the severity of coronary artery disease in various clinical settings, but its independent predictive value for LM/3VD has not been investigated in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to evaluate the independent predictive value of NLR for LM/3VD in NSTEMI patients.
METHODS/MATERIALS: We performed a retrospective analysis of consecutive NSTEMI patients who underwent coronary angiography. NLR was calculated as the ratio of neutrophil to lymphocyte based on the laboratory data on admission. The primary outcome was the presence of LM/3VD.
In all, 396 patients were included in the final analysis. Median NLR in the entire study population was 3.43 (interquartile range, 2.12-5.51). By receiver operating characteristics curve analysis, the optimal cutoff value of NLR in predicting LM/3VD was 2.80 (area under the curve 0.60, sensitivity 73%, specificity 43%). Of the 396 patients, 244 patients (62%) had NLR ≥2.8. Patients with NLR ≥2.8 were older and had a higher prevalence of LM/3VD (30 % vs. 18%, p=0.005). According to multivariate logistic regression analysis, NLR ≥2.8 was an independent predictor of LM/3VD after adjusting for other clinical variables including ST depression and ST elevation in lead aVR (odds ratio 1.83, 95% confidence interval 1.07-3.21, p=0.03).
Our study demonstrates that NLR ≥2.8 is an independent predictor of LM/3VD in patients with NSTEMI.
背景/目的：因左主干和/或三支血管病变（LM/3VD）导致急性冠状动脉综合征的患者发生短期和长期不良心血管事件的风险最高。中性粒细胞与淋巴细胞比值（NLR）已被证明在各种临床环境中可预测冠状动脉疾病的严重程度，但在非ST段抬高型心肌梗死（NSTEMI）患者中，其对LM/3VD的独立预测价值尚未得到研究。我们旨在评估NLR对NSTEMI患者LM/3VD的独立预测价值。
方法/材料：我们对连续接受冠状动脉造影的NSTEMI患者进行了回顾性分析。根据入院时的实验室数据计算NLR，即中性粒细胞与淋巴细胞的比值。主要结局是是否存在LM/3VD。
最终分析共纳入396例患者。整个研究人群的NLR中位数为3.43（四分位间距，2.12 - 5.51）。通过受试者工作特征曲线分析，NLR预测LM/3VD的最佳截断值为2.80（曲线下面积0.60，敏感性73%，特异性43%）。在396例患者中，244例（62%）的NLR≥2.8。NLR≥2.8的患者年龄更大，LM/3VD的患病率更高（30%对18%，p = 0.005）。根据多因素逻辑回归分析，在调整包括aVR导联ST段压低和ST段抬高在内的其他临床变量后，NLR≥2.8是LM/3VD的独立预测因素（比值比1.83，95%置信区间1.07 - 3.21，p = 0.03）。
我们的研究表明，NLR≥2.8是NSTEMI患者LM/3VD的独立预测因素。
