[Predictive value of neutrophil to lymphocyte ratio on long-term outcomes of acute myocardial infarction patients with multivessel disease].

Patients with acute coronary syndrome due to multivessel disease (MVD) were at the highest risk of adverse cardiovascular events. Neutrophil to lymphocyte ratio (NLR) was proposed as a marker of cardiovascular risk. Present study evaluated the independent predictive value of NLR for acute myocardial infarction (AMI) patients with MVD. AMI patients with MVD (1 433) underwent percutaneous coronary intervention (PCI) between January 2013 and December 2013 were followed up for 2 years. Patients were divided into 2 sub-groups based on an optimal cut off value of NLR to predict 2-year all-cause mortality. The primary endpoint was all-cause death. The secondary endpoint was long-term major adverse cardiovascular and cerebrovascular events (MACCE). By receiver operating characteristics curve analysis, the optimal cut-off value of admission NLR to predict 2-year all-cause mortality was 3.39 (area under the curve 0.765, sensitivity 71%, specificity 73%). The high NLR group(396) had higher prevalence of prior myocardial infarction, prior PCI and intra-aortic balloon pump use (IABP)(0.01). Compared to the low NLR group (1 037), patients in the high NLR group were older, had higher level of neutrophil count and high-sensitivity C-reactive protein (hs-CRP) (0.001), but lower level of lymphocyte count, estimated glomerular filtration rate (eGFR) and ejection fraction (0.001). During the follow-up period, rate of long-term all-cause death was significantly higher in the high NLR group than in the low NLR group (5.1% (20/396) vs. 0.8% (8/1 037), 0.001). Cardiac death (4.0% (16/396) vs. 0.7% (7/1 037), 0.001) and MACCE (21.7% (86/396) vs. 12.6% (131/1 037), 0.001) were also significantly higher in the high NLR group than in the low NLR group. Multivariate Cox analysis showed that NLR ≥ 3.39 was determined as an independent predictor of 2-year all-cause mortality (=3.23, 95% 1.38-7.54, 0.007) and MACCE (=1.58, 95% 1.19-2.10, 0.002) in this patient cohort after adjusting for other risk factors. Correlation analysis showed that the NLR was positively correlated with hs-CRP levels (0.241, 0.001). Our study demonstrates that admission NLR ≥ 3.39 is an independent predictor of long term all cause death and MACCE in AMI patients with MVD post PCI.