Abstract 4869: Association Between Admission Neutrophil to Lymphocyte Ratio and Angiographical Findings in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes
Background: Recently, neutrophil to lymphocyte ratio (NLR) was found to be an independent predictor of adverse outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS); however, its underlying mechanism remains unknown.
Methods: We examined the relation between NLR and coronary artery disease (CAD) progression in 290 patients with NSTE-ACS who underwent percutaneous coronary intervention, followed by planned coronary angiography 8 months later. The counts of white blood cell, neutrophils, and lymphocytes, high-sensitivity C-reactive protein (hsCRP) level, troponin T, estimated glomerular filtration rate (eGFR) and lipid profiles were measured on initial admission. Patients were divided into the 2 groups according to NLR at initial admission: G-H [NLR ≥2.53 (upper tertile), n=97] and G-L [NLR <2.53 (low and middle tertiles), n=193]. Rapid progression was defined as ≥10% diameter reduction of a pre-existing stenosis ≥50%, ≥30% diameter reduction of a stenosis <50% on follow-up coronary angiography.
Results: There were no differences in sex, hypertension, diabetes mellitus, smoking, troponin T, lipid profiles, medications, multivessel disease, and restenosis rate between the 2 groups. G-H patients were older (67±10 vs 65±9 years, p<0.05) and had less frequently hyperlipidemia (44% vs 59%, p=0.02), higher hsCRP level (0.233 vs 0.125 mg/dl, p=0.02), white blood cell count (8235±3205 vs 7004±2190/μl, p=0.009), and lower eGFR (65±17 vs 71±18 ml/min/1.73m2, p=0.02). G-H patients had more frequently culprit lesion with complex morphology (76% vs 61%, p=0.02), multiple complex lesion (57% vs 43%, p=0.007), rapid progression of non-culprit lesion (31% vs 15%, p=0.002), and adverse events (death, [re] infarction, or urgent revascularization) at 24 months (14% vs 5%, p=0.007). Multivariate analysis revealed that upper tertile of NLR (odds ratio 2.41, p=0.01) and upper tertile of hsCRP (odds ratio 2.29, p=0.01) were independently associated with rapid progression, but white blood cell count was not.
Conclusions: High NLR is associated with not only plaque vulnerability but also rapid CAD progression in patients with NSTE-ACS. These findings may partly explain adverse outcomes in patients with high NLR.