Li Qian, Yu Yue, Zhou Ya-Qiong, Zhao Yi, Wu Jin, Wu Yuan-Jing, DU Bin, Wang Pei-Jian, Zheng Tao
Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Cardiology, First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
J Geriatr Cardiol. 2024 May 28;21(5):542-549. doi: 10.26599/1671-5411.2024.05.007.
The neutrophil to lymphocyte ratio (NLR) has been reported as a novel predictor for atherosclerosis and cardiovascular outcomes. This study aimed to determine the effects of NLR on long-term clinical outcomes of chronic total occlusion (CTO) patients.
A total of 670 patients with CTO who met the inclusion criteria were included at the end of the follow-up period. Patients were divided into tertiles according to their baseline NLR levels at admission: low ( = 223), intermediate ( = 223), and high ( = 224). The incidence of major adverse cardiac events (MACEs) during the follow-up period, including all-cause death, nonfatal myocardial infarction (MI), or ischemia-driven revascularization, were compared among the three groups.
Major adverse cardiac events were observed in 27 patients (12.1%) in the low tertile, 40 (17.9%) in the intermediate tertile, and 61 (27.2%) in the high NLR tertile ( < 0.001). Kaplan-Meier analysis demonstrated a significantly higher incidence of MACE, ischemia-driven coronary revascularization, non-fatal MI, and mortality in patients within the high tertile than those in the low and intermediate groups (all < 0.001). Multivariable COX regression analysis showed that the high tertile of baseline NLR level showed a strong association with the risk of MACE (hazard ratio [HR] = 2.21; 95% confidence interval [CI]: 1.21-4.03; = 0.009), ischemia-driven coronary revascularization (HR = 3.19; 95% CI: 1.56-6.52; = 0.001), MI (HR = 2.61; 95% CI: 1.35-5.03; = 0.043) and mortality (HR = 3.78; 95% CI: 1.65-8.77; = 0.001).
Our findings suggest that NLR is an inexpensive and readily available biomarker that can independently predict cardiovascular risk in patients with CTO.
中性粒细胞与淋巴细胞比值（NLR）已被报道为动脉粥样硬化和心血管疾病预后的一种新型预测指标。本研究旨在确定NLR对慢性完全闭塞（CTO）患者长期临床预后的影响。
在随访期末，共纳入670例符合纳入标准的CTO患者。根据入院时的基线NLR水平将患者分为三分位数：低（=223）、中（=223）和高（=224）。比较三组随访期间主要不良心脏事件（MACE）的发生率，包括全因死亡、非致命性心肌梗死（MI）或缺血驱动的血运重建。
低三分位数组有27例患者（12.1%）发生主要不良心脏事件，中三分位数组有40例（17.9%），高NLR三分位数组有61例（27.2%）（<0.001）。Kaplan-Meier分析表明，高三分位数组患者的MACE、缺血驱动的冠状动脉血运重建、非致命性MI和死亡率的发生率显著高于低分组和中分组（均<0.001）。多变量COX回归分析显示，基线NLR水平的高三分位数与MACE风险（风险比[HR]=2.21；95%置信区间[CI]：1.21-4.03；=0.009）、缺血驱动的冠状动脉血运重建（HR=3.19；95%CI：1.56-6.52；=0.001）、MI（HR=2.61；95%CI：1.35-5.03；=0.043）和死亡率（HR=3.78；95%CI：1.65-8.77；=0.001）密切相关。
我们的研究结果表明，NLR是一种廉价且易于获得的生物标志物，可独立预测CTO患者的心血管风险。
