Advertisement

Usefulness of an Elevated Neutrophil to Lymphocyte Ratio in Predicting Long-Term Mortality After Percutaneous Coronary Intervention

Published:February 14, 2006DOI:https://doi.org/10.1016/j.amjcard.2005.10.034
      The neutrophil to lymphocyte (N/L) ratio is a recently described independent predictor of death/myocardial infarction in patients who have undergone coronary angiography. We hypothesized that an elevated N/L ratio would be a predictor of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). A total of 1,046 patients who underwent PCI were divided into tertiles based on their preprocedural N/L ratio (mean N/L ratio, tertile 1, 1.7 ± 0.5; tertile 2: 3.2 ± 0.6; tertile 3, 11.2 ± 12.9). Vital status was assessed using the Social Security Death Index. There were a total of 144 deaths over a mean follow-up of 32 months. The best survival was seen in tertile 1, with an increase in long-term mortality seen in tertiles 2 and 3 (p <0.0001). In multivariable modeling, after adjusting for age, chronic obstructive pulmonary disease, left ventricular ejection fraction, serum hemoglobin, serum creatinine, and lesion severity, the log N/L, but not the white blood cell count, was an independent significant predictor of long-term mortality (hazard ratio 1.85, 95% confidence interval 1.3, to 3.04, p = 0.01). The risk persisted when patients with an acute myocardial infarction were excluded from the analysis (hazard ratio 2.46, 95% confidence interval 1.4 to 4.4, p = 0.002). In conclusion, an elevated preprocedural N/L ratio in patients undergoing PCI is associated with an increased risk of long-term mortality.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bhatt D.L.
        • Topol E.J.
        Current role of platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes.
        JAMA. 2000; 284: 1549-1558
        • Ridker P.M.
        • Cushman M.
        • Stampfer M.J.
        • Tracy R.P.
        • Hennekens C.H.
        Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men.
        N Engl J Med. 1997; 336: 973-979
        • Gurm H.S.
        • Bhatt D.L.
        • Lincoff A.M.
        • Tcheng J.E.
        • Kereiakes D.J.
        • Kleiman N.S.
        • Jia G.
        • Topol E.J.
        Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention.
        Heart. 2003; 89: 1200-1204
        • Yen M.H.
        • Bhatt D.L.
        • Chew D.P.
        • Harrington R.A.
        • Newby L.K.
        • Ardissino D.
        • Van de Werf F.
        • White J.A.
        • Moliterno D.J.
        • Topol E.J.
        Association between admission white blood cell count and one-year mortality in patients with acute coronary syndromes.
        Am J Med. 2003; 115: 318-321
        • Barron H.V.
        • Cannon C.P.
        • Murphy S.A.
        • Braunwald E.
        • Gibson C.M.
        Association between white blood cell count, epicardial blood flow, myocardial perfusion, and clinical outcomes in the setting of acute myocardial infarction.
        Circulation. 2000; 102: 2329-2334
        • Furman M.I.
        • Becker R.C.
        • Yarzebski J.
        • Gore J.M.
        • Goldberg R.J.
        Effect of elevated leukocyte count on in-hospital mortality following acute myocardial infarction.
        Am J Cardiol. 1996; 78: 945-948
        • Cole D.R.
        • Singian E.B.
        • Kate L.N.
        The long-term prognosis following myocardial infarction, and some factors which affect it.
        Circulation. 1954; 9: 321-324
        • Bhatt D.L.
        • Chew D.P.
        • Lincoff M.A.
        • Simoons M.L.
        • Harrington R.A.
        • Ommen S.R.
        • Jia G.
        • Topol E.J.
        • PURSUIT Investigators
        Effect of revascularization on mortality associated with an elevated white blood cell count in acute coronary syndromes.
        Am J Cardiol. 2003; 92: 136-140
        • Cannon C.P.
        • McCabe C.H.
        • Wilcox R.G.
        • Bentley J.H.
        • Braunwald E.
        • OPUS-TIMI 16 Investigators
        Association of the white blood cell count with increased mortality in acute myocardial infarction and unstable angina pectoris.
        Am J Cardiol. 2001; 87: 636-639
        • Horne B.D.
        • Anderson J.L.
        • John J.M.
        • Weaver A.
        • Bair T.L.
        • Jensen K.R.
        • Renlund D.G.
        • Muhlestein J.B.
        Which white blood cell subtypes predict increased cardiovascular risk?.
        J Am Coll Cardiol. 2005; 45: 1638-1643
        • Rajagopal V.
        • Gurm H.S.
        • Bhatt D.L.
        • Lincoff M.A.
        • Tcheng J.E.
        • Kereiakes D.J.
        • Kleiman N.S.
        • Jia G.
        • Topol E.J.
        Relation of an elevated white blood cell count after percutaneous coronary intervention to long-term mortality.
        Am J Cardiol. 2004; 94: 190-192
        • Gurm H.S.
        • Bhatt D.L.
        • Gupta R.
        • Eillis S.G.
        • Topol E.J.
        • Lauer M.S.
        Preprocedural white blood cell count mortality after percutaneous coronary intervention.
        Am Heart J. 2003; 146: 692-698
        • Kawaguchi H.
        • Mori T.
        • Kawano T.
        • Kono S.
        • Sasaki J.
        • Arakawa K.
        Band neutrophil count and the presence and severity of coronary atherosclerosis.
        Am Heart J. 1996; 132: 9-12
        • Chapman C.M.L.
        • Beiby J.P.
        • McQuillan B.M.
        • Thompson P.L.
        • Hung J.
        Monocyte count, but not C-reactive protein or interleukin-6, is an independent risk marker for subclinical carotid atherosclerosis.
        Stroke. 2004; 35: 1619-1624