Usefulness of Neutrophil to Lymphocyte Ratio in Predicting Short- and Long-Term Mortality After Non–ST-Elevation Myocardial Infarction

Azab, Basem; Zaher, Medhat; Weiserbs, Kera F.; Torbey, Estelle; Lacossiere, Kenson; Gaddam, Sainath; Gobunsuy, Romel; Jadonath, Sunil; Baldari, Duccio; McCord, Donald; Lafferty, James

doi:10.1016/j.amjcard.2010.03.062

« Previous Next »American Journal of Cardiology
Volume 106, Issue 4 , Pages 470-476, 15 August 2010

Usefulness of Neutrophil to Lymphocyte Ratio in Predicting Short- and Long-Term Mortality After Non–ST-Elevation Myocardial Infarction

Basem Azab, MD
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, New York
- Corresponding author: Tel: 347-607-8727; fax: 718-226-6164
Medhat Zaher, MD
- Department of Cardiology, Staten Island University Hospital, Staten Island, New York, New York
Kera F. Weiserbs, PhD
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, New York
Estelle Torbey, MD
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, New York
Kenson Lacossiere, MD
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, New York
Sainath Gaddam, MD
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, New York
Romel Gobunsuy, MD
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, New York
Sunil Jadonath, MD
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, New York
Duccio Baldari, MD
- Department of Cardiology, Staten Island University Hospital, Staten Island, New York, New York
Donald McCord, MD
- Department of Cardiology, Staten Island University Hospital, Staten Island, New York, New York
James Lafferty, MD
- Department of Cardiology, Staten Island University Hospital, Staten Island, New York, New York

Received 5 February 2010; received in revised form 25 March 2010; accepted 25 March 2010.

Neutrophil/lymphocyte ratio (NLR) is the strongest white blood cell predictor of adverse outcomes in stable and unstable coronary artery syndromes. The aim of our study was to explore the utility of NLR in predicting long-term mortality in patients with non–ST-segment elevation myocardial infarction (NSTEMI). Consecutive patients with NSTEMI at Staten Island University Hospital were evaluated for study inclusion. Of the 1,345 patients with NSTEMI admitted from September 2004 to September 2006, 619 qualified for study inclusion. Survival analysis, stratified by NLR tertiles, was used to evaluate the predictive value of average inpatient NLR levels. Four-year vital status was accessed with electronic medical records and Social Security Death Index. Patients in the highest NLR tertile (NLR >4.7) had a higher 4-year mortality rate (29.8% vs 8.4%) compared to those in the lowest tertile (NLR <3, Wilcoxon chi-square 34.64, p <0.0001). After controlling for Global Registry of Acute Coronary Events risk profile scores, average NLR level remained a significant predictor of inpatient and 4-year mortality. Hazard ratios per unit increase of average NLR (log) increased by 1.06 (p = 0.0133) and 1.09 (p = 0.0006), respectively. In conclusion, NLR is an independent predictor of short-term and long-term mortalities in patients with NSTEMI with an average NLR >4.7. We strongly suggest the use of NLR rather than other leukocyte parameters (e.g., total white blood cell count) in risk stratification of the NSTEMI population.