Abstract 9508: Neutrophil to Lymphocyte Ratio Predicts Short and Long Term Mortality After Revascularized ST Elevation Myocardial Infarction
Introduction: Several biomarkers of inflammation have been implicated in the pathogenesis of acute coronary syndromes. The role of inflammatory markers in predicting short and long term survival after revascularized STEMI remains poorly defined.
Patient and methods: We retrospectively evaluated 250 consecutive STEMI patients admitted to a tertiary care center over one year. Exclusion criteria included:acute sepsis, trauma, recent surgery or underlying malignancy. Data analyzed included demographics, clinical presentation, leukocyte markers, electrocardiograms, therapy and major adverse cardiac events.
Results: Mean age was 62±15 years, 70.4% subjects were males, almost equal number were Caucasians (49.4%) and non-Caucasians with mean follow up of 571±291 (Median=730) days. Considering available inflammatory markers, univariate predictors of mortality included only White Cell Count (14.52±8.09*103/microliter;p<0.001) and neutrophil to lymphocyte ratio [NLR] (9.12±8.75;p=0.011). Multivariate regression analysis of all univariate predictors revealed NLR (OR=2.64;p=0.026), female gender (OR=5.35;p<0.001), cerebrovascular accident history (OR=3.36;p=0.023), low glomerular filtration rate (OR=0.98;p=0.012) and cardiac arrest on admission (OR=17.43;p<0.001) as independent predictors of 2-year mortality. NLR was subdivided based on an optimal cut off value (OCV) of 7.4, when combined with Thrombolysis in Myocardial Infarction (TIMI) Score provided the highest predictive power for mortality with Area Under the Curve (AUC) of 0.799 (95 CI:0.734,0.865;p<0.001). Short term (30 days) and long term (2-years) mortality stratified by NLR (Figure 1-A) and Kaplan Meier survival analysis (Figure 1-B) are illustrated.
Conclusion: NLR based on OCV of 7.4 is an excellent predictor of short and long term survival with additive prognostic value to conventional clinical and angiographic scoring systems used for revascularized STEMI patients.
- © 2013 by American Heart Association, Inc.