Pinheiro Machado Guilherme, Araujo Gustavo N, Carpes Christian K, Lech Mateus C, Mariani Stefani, Valle Felipe H, Bergoli Luiz C C, Wainstein Rodrigo V, Wainstein Marco V
Department of Cardiology, School of Medicine, Federal University of Rio Grande do Sul.
Department of Cardiology, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Coron Artery Dis. 2019 Jan;30(1):20-25. doi: 10.1097/MCA.0000000000000671.
Elevated neutrophil-to-lymphocyte ratio (NLR) is an indirect marker of inflammation, and is associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the usefulness of NLR to predict procedural adverse events is patients who underwent primary percutaneous coronary intervention (PCI).
Consecutive patients with STEMI who underwent primary PCI were divided into low and high NLR, whereas high was defined as an NLR value above 75° percentile (≥9.45). The occurrence of procedural complications, in-hospital, and 30-day major adverse cardiovascular events and 1-year all-cause mortality were evaluated.
We included 664 patients with a mean age of 60.5 (±12.1) years and 66.3% were male. In multivariate analysis, NLR remained an independent predictor of in-hospital death [relative risk (RR)=1.03; 95% confidence interval (CI)=1.00-1.08; P=0.04], contrast-induced nephropathy (RR=2.35; 95% CI=1.11-4.71; P=0.02), distal embolization (RR=2.72; 95% CI=1.55-4.75; P<0.001), and no-reflow (RR=2.31; 95% CI=2.31-4.68; P=0.01). The area under the curve for distal embolization was 0.67, 0.64 for no-reflow and 0.62 for procedural complications. A low value of NLR had an excellent negative predictive value of 97.8, 96.9, and 92.1 for distal embolization, no-reflow, and procedural complications, respectively.
High NLR is an independent predictor of distal embolization, no-reflow, and procedural complications in patients with STEMI who underwent primary PCI. A low NLR value has an excellent negative predictive value for these procedural outcomes. NLR may be a useful and inexpensive tool that may be used at bedside.
中性粒细胞与淋巴细胞比值（NLR）升高是炎症的间接标志物，与ST段抬高型心肌梗死（STEMI）患者的不良临床结局相关。本研究的目的是探讨NLR对接受直接经皮冠状动脉介入治疗（PCI）患者手术不良事件的预测价值。
连续入选接受直接PCI的STEMI患者，分为低NLR组和高NLR组，高NLR定义为高于第75百分位数（≥9.45）。评估手术并发症、住院期间及30天主要不良心血管事件和1年全因死亡率的发生情况。
我们纳入了664例患者，平均年龄60.5（±12.1）岁，66.3%为男性。多因素分析显示，NLR仍然是住院死亡[相对危险度（RR）=1.03；95%置信区间（CI）=1.00-1.08；P=0.04]、造影剂肾病（RR=2.35；95%CI=1.11-4.71；P=0.02）、远端栓塞（RR=2.72；95%CI=1.55-4.75；P<0.001）和无复流（RR=2.31；95%CI=2.31-4.68；P=0.01）的独立预测因素。远端栓塞的曲线下面积为0.67，无复流为0.64，手术并发症为0.62。低NLR值对远端栓塞、无复流和手术并发症的阴性预测值分别为97.8、96.9和92.1。
高NLR是接受直接PCI的STEMI患者远端栓塞、无复流和手术并发症的独立预测因素。低NLR值对这些手术结局具有良好的阴性预测价值。NLR可能是一种有用且廉价的工具，可在床边使用。
