Investigation of relationship between coronary angiography results and neutrophil/lymphocyte ratios of patients with acute coronary syndrome in the emergency department
Keywords:Acute coronary syndrome, neutrophil, lymphocyte, monocytes, neutrophil/lymphocyte ratio
Purpose: We aimed to identify patients diagnosed with acute coronary syndrome (ACS) in the emergency department and for whom medical treatment was decided during coronary angiography, according to their neutrophil/lymphocyte ratios at the time of admission.
Material and Method: Patients diagnosed with ACS in the emergency department and undergoing coronary angiography (CAG) were included. The patients were divided into two groups as non-ST-segment elevation acute coronary syndrome and ST-segment elevation myocardial infarction. According to their CAG results, the patients in both groups were classified as those who underwent coronary intervention and those who did not. In addition, demographic data such as age and gender, neutrophil/lymphocyte ratio, monocytes, aspartate aminotransferase, and C-reactive protein values of these patients were recorded in the data form. These values were statistically compared between those who decided on a coronary intervention during CAG and those who did not.
Results: A total of 647 patients were included in the study. The patients were divided into 325 patients with non-ST-segment elevation acute coronary syndrome and 322 with ST-segment elevation myocardial infarction. The age range of the patients in both groups was 30 to 93. Monocyte, aspartate aminotransferase, neutrophil/lymphocyte ratio, and gender were significant in the diagnosis process. The diagnosis was the only effective factor in detecting patients for whom a coronary intervention was decided during CAG. Gender, age, neutrophil/lymphocyte ratio, aspartate aminotransferase, C-reactive protein, and monocyte values were insignificant.
Conclusion: Even if some parameters such as monocyte count, N/L ratio, and aspartate aminotransferase in patients diagnosed with ACS in the emergency department are ineffective in predicting the medical treatment decision during CAG, they may help in the clinical decision-making process.
Barquera S, Pedroza-Tobias A, Medina C, Hernandez-Barrera L, Bibbins-Domingo K, Lozano R, Moran A E. Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease. Arch Med Res. 2015;46(5):328-338.
Akturan S, Gümüş B, Özer Ö, Balandız H, Erenler A K. Death Rates and Causes of Death in Turkey Between 2009 and 2016 Based on TUIK Data.
The top 10 causes of death. Why do we need to know the reasons people die?. [Internet] Media Center. World Health Organization. [cited 2019 February 28]. Available from: http://www.who.int/mediacentre/factsheets/fs310/en/index2.html
Kasapoğlu E S, Enç N. A Guide for Coronary Artery Patients. Journal of Cardiovascular Nursing 2017;8(15):1-7
Balta S, Demirkol S, Celik T, Kucuk U, Unlu M, Arslan Z et al. Association between coronary artery ectasia and neutrophil-lymphocyte ratio. Angiology 2013;64(8):627-32.
Çelik S, Eren N, Er A, Turgay F, Ciğerli Ş, Kılıçkesmez K, Serin E. Comparison of Neutrophil/Lymphocyte Ratio and Red Blood Cell Distribution Width with Cardiac Markers in Acute Coronary Syndrome. Türk Klinik Biyokimya Derg. 2016;14(3):172-180
Collinson P, Premachandram S, Hashemi K. Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department Commentary: Time for improved diagnosis and management of patients presenting with acute chest pain. BMJ. 2000;320(7251):1702-1705.
Fowler AJ, Agha RA. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography-The growing versatility of NLR. Atherosclerosis. 2013;228(1):44-5.
Kleinbaum, D. G., Dietz, K., Gail, M., Klein, M., & Klein, M. (2002). Logistic regression. New York: Springer-Verlag.
Bircan, H. (2004). Lojistik regresyon analizi: Tıp verileri üzerine bir uygulama. Kocaeli Üniversitesi Sosyal Bilimler Dergisi, (8), 185-208.
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Circulation. 2012;126:2020–2035.
Go AS, Mozaffarian D, Roger VL, Benjamin EL, Berry JD, Borden WB, Bravata DM, et al. Heart disease and stroke statistics—2013 update: A report from the American Heart Association. Circulation. 2013;127:e6–e245.
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey Jr. DE, Chaveyll WE, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): Developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation. 2007;116:e148–e304.
O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78–e140.
Navarese EP, Gurbel PA, Andreotti F, et al. Optimal timing of coronary invasive strategy in non-ST-segment elevation acute coronary syndromes: A systematic review and meta-analysis. Ann Intern Med. 2013;158:261–270.
Caglar B, Serin S. Diagnostic Performance of One-hour Delta High Sensitive Troponin in Acute Coronary Syndrome. J Coll Physicians Surg Pak. 2020;30(9):906-911.
Nowak RM, Gandolfo CM, Jacobsen G, Christenson RH, Moyer M, Hudson M, et al. Ultrarapid rule-out for acute myocardial infarction using the Generation 5 cardiac troponin T assay: Results from the REACTION-US study. Ann Emerg Med 2018; 72(6):654–64.
Canto JG, Shlipak MG, Rogers WJ, et al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA. 2000;283(24):3223–3229.
Canto JG, Rogers WJ, Goldberg RJ, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307:813–822.
ten Haaf ME, Bax M, ten Berg JM, Brouwer J, van’t Hof AW, van der Schaaf RJ, Stella PR, Tjon Joe Gin RM, Tonino PA, de Vries AG, Zijlstra F, Boersma E, Appelman Y. Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands. Neth Heart J. 2019;27(5): 263–271.
Emerging Risk Factors Collaboration, Kaptoge S, Di Angelantonio E, Pennells L, Wood AM, White IR, et al. C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med. 2012;367:1310–20.
Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107:499–511
Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105(9):1135–43.
Hansen PR. Role of neutrophils in myocardial ischemia and reperfusion. Circulation 1995;91:1872–85.
Widmer A, Linka AZ, Attenhofer Jost CH, Buergi B, BrunnerLa Rocca HP, Salomon F, et al. Mechanical complications after myocardial infarction reliably predicted using C-reactive protein levels and lymphocytopenia. Cardiology. 2003;99(1):25–31.
Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol 2000;15;86(4):449–51.
Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol. 2010;106:470–6.
Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, et al. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke. 2004;35(5):1147–1152.)
Kalay N, Dogdu O, Koc F, et al. Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology. 2012;63(3):213–217.
Wang X, Zhang G, Jiang X, Zhu H, Lu Z, Xu L. Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: a meta-analysis of observational studies. Atherosclerosis. 2014;234(1):206–213.
Ayça B, Akın F, Celik O, et al. Neutrophil to lymphocyte ratio is related to stent thrombosis and high mortality in patients with acute myocardial infarction. Angiology. 2015;66(6):545–552.
Gillum RF, Mussolino ME, Madans JH. Counts of neutrophils, lymphocytes, and monocytes, cause‐specific mortality and coronary heart disease: The NHANES‐I epidemiologic follow-up study. Ann Epidemiol 2005;15(4):266–71.
Yousuf O, Mohanty BD, Martin SS, et al. High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link? J Am Coll Cardiol. 2013;62(5):397–408.
Tomai F, Ribichini F, Ghini AS, et al. Elevated C-reactive protein levels and coronary microvascular dysfunction in patients with coronary artery disease. Eur Heart J. 2005;26(20):2099–2105.
Duman H, Çinier G, Bakırcı EM, Duman H, Şimşek Z, Hamur H, Değirmenci H, Emlek N. Relationship Between C-Reactive Protein to Albumin Ratio and Thrombus Burden in Patients With Acute Coronary Syndrome. Clin Appl Thromb Hemost. 2019;25:1-6.
Nozawa N, Hibi K, Endo M, et al. Association Between Circulating Monocytes and Coronary Plaque Progression in Patients With Acute Myocardial Infarction. Circ J 2010;74(7):1384–91.
Afiune Neto A, Mansur A de P, Avakian SD, Gomes EPSG, Ramires JAF. Monocytosis is an independent risk marker for coronary artery disease. Arq Bras Cardiol 2006;86(3):240–4.
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