Association between Neutrophil-to-Lymphocyte Ratio and the Systemic Inflammatory Immunologic Index and the Angiographic SYNTAX Score and the TIMI Flow Grade in Acute STEMI: A Cohort Study
-
Ali Rostami
,
Arezou Tajlil
,
Ahmad Separham
,
Bahram Sohrabi
,
Leili Pourafkari
,
Neda Roshanravan
,
Naser Aslanabadi
,
Mojtaba Ziaee
,
Sina Mashayekhi
,
Samad Ghaffari
Abstract
Background: In patients with ST-segment-elevation myocardial infarction (STEMI), it is essential to determine the complexity of coronary lesions on presentation and predict the risk of no-reflow after primary percutaneous coronary intervention (pPCI). Given that inflammation plays an important role in the pathogenesis of atherosclerosis, using inflammatory indices might be helpful in this setting.
Methods: This prospective cohort study recruited 200 consecutive patients with STEMI who underwent pPCI. The presentation neutrophil-to-lymphocyte-ratio (NLR) and the systemic inflammatory immunologic index (SII), calculated using the formula platelets × neutrophils/lymphocytes, were recorded. Study outcomes included the SYNTAX score and the TIMI flow grade before and after pPCI. The associations between the NLR and the SII and the study outcomes were investigated using univariate and multivariate logistic regression analyses.
Results: Among 200 patients at a mean age of 59.85±11.23 years, 160 (80.0%) were male and 40 (20.0%) were female. The NLR and SII values were not statistically different between the 3 SYNTAX subgroups. While the mean NLR and SII values were similar between the patients with preprocedural TIMI flow grades 0/1 and 2/3, the mean NLR and SII were significantly lower in the group with a postprocedural TIMI flow grade 3. After adjustments for age and sex, the NLR and the SII were independent predictors of postprocedural no-reflow.
Conclusion: In patients with STEMI, the presentation NLR and SII are useful for predicting the risk of no-reflow after pPCI. However, the NLR and the SII are not predictors of the SYNTAX score and the preprocedural TIMI flow grade.
1. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 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.
2. Ndrepepa G, Tiroch K, Keta D, Fusaro M, Seyfarth M, Pache J, Mehilli J, Schomig A, Kastrati A. Predictive factors and impact of no reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction. Circ Cardiovasc Interv 2010;3:27-33.
3. Bailleul C, Aissaoui N, Cayla G, Dillinger JG, Jouve B, Schiele F, Ferrieres J, Simon T, Danchin N, Puymirat E. Prognostic impact of prepercutaneous coronary intervention TIMI flow in patients with ST-segment and non-ST-segment elevation myocardial infarction: Results from the FAST-MI 2010 registry. Arch Cardiovasc Dis 2018;111:101-108.
4. Choudhary S. Association of syntax score with short-term outcomes among acute ST-elevation myocardial infarction patients undergoing primary PCI. Indian Heart J 2017;69:S20-S23.
5. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005;1:219-227.
6. Bundhun PK, Sookharee Y, Bholee A, Huang F. Application of the SYNTAX score in interventional cardiology: A systematic review and meta-analysis. Medicine 2017;96:e7410-e7410.
7. Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, Ergin A, Gibson CM. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2012;110:621-627.
8. Kurtul S, Sarli B, Baktir AO, Demirbas M, Saglam H, Dogan Y, Sahin O, Akpek M, Odabas H, Arinc H, Kaya MG. Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with non-ST segment elevation myocardial infarction. Int Heart J 2015;56:18-21.
9. Sahin DY, Elbasan Z, Gur M, Yildiz A, Akpinar O, Icen YK, Turkoglu C, Tekin K, Kuloglu O, Cayli M. Neutrophil to lymphocyte ratio is associated with the severity of coronary artery disease in patients with ST-segment elevation myocardial infarction. Angiology 2013;64:423-429.
10. Sahin DY, Gur M, Elbasan Z, Yildiz A, Kaya Z, Icen YK, Kivrak A, Turkoglu C, Yilmaz R, Cayli M. Predictors of preinterventional patency of infarct-related artery in patients with ST-segment elevation myocardial infarction: Importance of neutrophil to lymphocyte ratio and uric acid level. Exp Clin Cardiol 2013;18:e77-81.
11. Acet H, Ertas F, Bilik MZ, Akil MA, Ozyurtlu F, Aydin M, Oylumlu M, Polat N, Yuksel M, Yildiz A, Kaya H, Akyuz A, Aycicek H, Ozbek M, Toprak N. The relationship between neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and thrombolysis in myocardial infarction risk score in patients with ST elevation acute myocardial infarction before primary coronary intervention. Postepy Kardiol Interwencyjnej 2015;11:126-135.
12. Turkmen S, Dogdu O, Tekin K, Kucukdurmaz Z, Cagliyan CE, Sarikaya S, Yucel H, Karapinar H, Ozkan B, Uysal OK, Basara A, Sancaktar E, Yilmaz A. The relationship between neutrophil/lymphocyte ratio and the TIMI flow grade in patients with STEMI undergoing primary PCI. Eur Rev Med Pharmacol Sci 2013;17:2185-2189.
13. Hong X, Cui B, Wang M, Yang Z, Wang L, Xu Q. Systemic immune-inflammation index, based on platelet counts and neutrophil-lymphocyte ratio, is useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med 2015;236:297-304.
14. Fest J, Ruiter R, Ikram MA, Voortman T, van Eijck CHJ, Stricker BH. Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a population-based prospective cohort study. Sci Rep 2018;8:10566.
15. Huang H, Liu Q, Zhu L, Zhang Y, Lu X, Wu Y, Liu L. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer. Sci Rep 2019;9:3284.
16. Shi H, Jiang Y, Cao H, Zhu H, Chen B, Ji W. Nomogram based on systemic immune-inflammation index to predict overall survival in gastric cancer patients. Dis Markers 2018;2018:1787424.
17. Valero C, Pardo L, Sansa A, Garcia Lorenzo J, López M, Quer M, León X. Prognostic capacity of Systemic Inflammation Response Index (SIRI) in patients with head and neck squamous cell carcinoma. Head & Neck 2020;42:336-343.
18. Ackland GL, Abbott TEF, Cain D, Edwards MR, Sultan P, Karmali SN, Fowler AJ, Whittle JR, MacDonald NJ, Reyes A, Paredes LG, Stephens RCM, Del Arroyo AG, Woldman S, Archbold RA, Wragg A, Kam E, Ahmad T, Khan AW, Niebrzegowska E, Pearse RM. Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery. Br J Anaesth 2019;122:180-187.
19. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Stahle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-972.
20. Group TS. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 1985;312:932-936.
21. Karabağ Y, Çağdaş M, Rencuzogullari I, Karakoyun S, Artaç İ, İliş D, Yesin M, Çağdaş ÖS, Altıntaş B, Burak C, Tanboğa HI. Usefulness of the c-reactive protein/albumin ratio for predicting no-reflow in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Eur J Clin Invest 2018;48:e12928.
22. Lee MJ, Park SD, Kwon SW, Woo SI, Lee MD, Shin SH, Kim DH, Kwan J, Park KS. Relation between neutrophil-to-lymphocyte ratio and index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2016;118:1323-1328.
23. Karahan Z, Ucaman B, Ulug AV, Aydinalp O, Ugurlu M, Cevik K, Kaya I, Ozturk O. Effect of hematologic parameters on microvascular reperfusion in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Angiology 2016;67:151-156.
24. Sen N, Afsar B, Ozcan F, Buyukkaya E, Isleyen A, Akcay AB, Yuzgecer H, Kurt M, Karakas MF, Basar N, Hajro E, Kanbay M. The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Atherosclerosis 2013;228:203-210.
25. Yayla C, Akboga MK, Canpolat U, Akyel A, Yayla KG, Dogan M, Yeter E, Aydogdu S. Platelet to lymphocyte ratio can be a predictor of infarct-related artery patency in patients with ST-segment elevation myocardial infarction. Angiology 2015;66:831-836.
26. Kurtul A, Murat SN, Yarlioglues M, Duran M, Karadeniz M, Ergun G, Ocek AH. The relationship between neutrophil/lymphocyte ratio and infarct-related artery patency before mechanical reperfusion in patients with ST-elevation myocardial infarction. Coron Artery Dis 2014;25:159-166.
27. Taleb S. Inflammation in atherosclerosis. Arch Cardiovasc Dis 2016;109:708-715.
28. Brown RA, Shantsila E, Varma C, Lip GY. Current understanding of atherogenesis. Am J Med 2017;130:268-282.
29. Sadat U, Jaffer FA, van Zandvoort MA, Nicholls SJ, Ribatti D, Gillard JH. Inflammation and neovascularization intertwined in atherosclerosis: imaging of structural and molecular imaging targets. Circulation 2014;130:786-794.
30. Hansson GK, Hermansson A. The immune system in atherosclerosis. Nat Immunol 2011;12:204-212.
31. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685-1695.
32. Sattur S, Sarwar B, Sacchi TJ, Brener SJ. Correlation between markers of reperfusion and mortality in ST-elevation myocardial infarction: a systematic review. J Invasive Cardiol 2014;26:587-595.
33. Sezer M, van Royen N, Umman B, Bugra Z, Bulluck H, Hausenloy DJ, Umman S. Coronary microvascular injury in reperfused acute myocardial infarction: a view from an integrative perspective. J Am Heart Assoc 2018;7:e009949.
34. Aurigemma C, Scalone G, Tomai F, Altamura L, De Persio G, Stazi A, Lanza GA, Crea F. Persistent enhanced platelet activation in patients with acute myocardial infarction and coronary microvascular obstruction: clinical implications. Thromb Haemost 2014;111:122-130.
35. Ziegler M, Wang X, Peter K. Platelets in cardiac ischaemia/reperfusion injury: a promising therapeutic target. Cardiovasc Res 2019;115:1178-1188.
36. Kohler D, Straub A, Weissmuller T, Faigle M, Bender S, Lehmann R, Wendel HP, Kurz J, Walter U, Zacharowski K, Rosenberger P. Phosphorylation of vasodilator-stimulated phosphoprotein prevents platelet-neutrophil complex formation and dampens myocardial ischemia-reperfusion injury. Circulation 2011;123:2579-2590.
37. Niccoli G, Montone Rocco A, Ibanez B, Thiele H, Crea F, Heusch G, Bulluck H, Hausenloy Derek J, Berry C, Stiermaier T, Camici Paolo G, Eitel I. Optimized treatment of ST-elevation myocardial infarction. Circ Res 2019;125:245-258.
2. Ndrepepa G, Tiroch K, Keta D, Fusaro M, Seyfarth M, Pache J, Mehilli J, Schomig A, Kastrati A. Predictive factors and impact of no reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction. Circ Cardiovasc Interv 2010;3:27-33.
3. Bailleul C, Aissaoui N, Cayla G, Dillinger JG, Jouve B, Schiele F, Ferrieres J, Simon T, Danchin N, Puymirat E. Prognostic impact of prepercutaneous coronary intervention TIMI flow in patients with ST-segment and non-ST-segment elevation myocardial infarction: Results from the FAST-MI 2010 registry. Arch Cardiovasc Dis 2018;111:101-108.
4. Choudhary S. Association of syntax score with short-term outcomes among acute ST-elevation myocardial infarction patients undergoing primary PCI. Indian Heart J 2017;69:S20-S23.
5. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005;1:219-227.
6. Bundhun PK, Sookharee Y, Bholee A, Huang F. Application of the SYNTAX score in interventional cardiology: A systematic review and meta-analysis. Medicine 2017;96:e7410-e7410.
7. Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, Ergin A, Gibson CM. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2012;110:621-627.
8. Kurtul S, Sarli B, Baktir AO, Demirbas M, Saglam H, Dogan Y, Sahin O, Akpek M, Odabas H, Arinc H, Kaya MG. Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with non-ST segment elevation myocardial infarction. Int Heart J 2015;56:18-21.
9. Sahin DY, Elbasan Z, Gur M, Yildiz A, Akpinar O, Icen YK, Turkoglu C, Tekin K, Kuloglu O, Cayli M. Neutrophil to lymphocyte ratio is associated with the severity of coronary artery disease in patients with ST-segment elevation myocardial infarction. Angiology 2013;64:423-429.
10. Sahin DY, Gur M, Elbasan Z, Yildiz A, Kaya Z, Icen YK, Kivrak A, Turkoglu C, Yilmaz R, Cayli M. Predictors of preinterventional patency of infarct-related artery in patients with ST-segment elevation myocardial infarction: Importance of neutrophil to lymphocyte ratio and uric acid level. Exp Clin Cardiol 2013;18:e77-81.
11. Acet H, Ertas F, Bilik MZ, Akil MA, Ozyurtlu F, Aydin M, Oylumlu M, Polat N, Yuksel M, Yildiz A, Kaya H, Akyuz A, Aycicek H, Ozbek M, Toprak N. The relationship between neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and thrombolysis in myocardial infarction risk score in patients with ST elevation acute myocardial infarction before primary coronary intervention. Postepy Kardiol Interwencyjnej 2015;11:126-135.
12. Turkmen S, Dogdu O, Tekin K, Kucukdurmaz Z, Cagliyan CE, Sarikaya S, Yucel H, Karapinar H, Ozkan B, Uysal OK, Basara A, Sancaktar E, Yilmaz A. The relationship between neutrophil/lymphocyte ratio and the TIMI flow grade in patients with STEMI undergoing primary PCI. Eur Rev Med Pharmacol Sci 2013;17:2185-2189.
13. Hong X, Cui B, Wang M, Yang Z, Wang L, Xu Q. Systemic immune-inflammation index, based on platelet counts and neutrophil-lymphocyte ratio, is useful for predicting prognosis in small cell lung cancer. Tohoku J Exp Med 2015;236:297-304.
14. Fest J, Ruiter R, Ikram MA, Voortman T, van Eijck CHJ, Stricker BH. Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a population-based prospective cohort study. Sci Rep 2018;8:10566.
15. Huang H, Liu Q, Zhu L, Zhang Y, Lu X, Wu Y, Liu L. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer. Sci Rep 2019;9:3284.
16. Shi H, Jiang Y, Cao H, Zhu H, Chen B, Ji W. Nomogram based on systemic immune-inflammation index to predict overall survival in gastric cancer patients. Dis Markers 2018;2018:1787424.
17. Valero C, Pardo L, Sansa A, Garcia Lorenzo J, López M, Quer M, León X. Prognostic capacity of Systemic Inflammation Response Index (SIRI) in patients with head and neck squamous cell carcinoma. Head & Neck 2020;42:336-343.
18. Ackland GL, Abbott TEF, Cain D, Edwards MR, Sultan P, Karmali SN, Fowler AJ, Whittle JR, MacDonald NJ, Reyes A, Paredes LG, Stephens RCM, Del Arroyo AG, Woldman S, Archbold RA, Wragg A, Kam E, Ahmad T, Khan AW, Niebrzegowska E, Pearse RM. Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery. Br J Anaesth 2019;122:180-187.
19. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Stahle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-972.
20. Group TS. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 1985;312:932-936.
21. Karabağ Y, Çağdaş M, Rencuzogullari I, Karakoyun S, Artaç İ, İliş D, Yesin M, Çağdaş ÖS, Altıntaş B, Burak C, Tanboğa HI. Usefulness of the c-reactive protein/albumin ratio for predicting no-reflow in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Eur J Clin Invest 2018;48:e12928.
22. Lee MJ, Park SD, Kwon SW, Woo SI, Lee MD, Shin SH, Kim DH, Kwan J, Park KS. Relation between neutrophil-to-lymphocyte ratio and index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2016;118:1323-1328.
23. Karahan Z, Ucaman B, Ulug AV, Aydinalp O, Ugurlu M, Cevik K, Kaya I, Ozturk O. Effect of hematologic parameters on microvascular reperfusion in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Angiology 2016;67:151-156.
24. Sen N, Afsar B, Ozcan F, Buyukkaya E, Isleyen A, Akcay AB, Yuzgecer H, Kurt M, Karakas MF, Basar N, Hajro E, Kanbay M. The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Atherosclerosis 2013;228:203-210.
25. Yayla C, Akboga MK, Canpolat U, Akyel A, Yayla KG, Dogan M, Yeter E, Aydogdu S. Platelet to lymphocyte ratio can be a predictor of infarct-related artery patency in patients with ST-segment elevation myocardial infarction. Angiology 2015;66:831-836.
26. Kurtul A, Murat SN, Yarlioglues M, Duran M, Karadeniz M, Ergun G, Ocek AH. The relationship between neutrophil/lymphocyte ratio and infarct-related artery patency before mechanical reperfusion in patients with ST-elevation myocardial infarction. Coron Artery Dis 2014;25:159-166.
27. Taleb S. Inflammation in atherosclerosis. Arch Cardiovasc Dis 2016;109:708-715.
28. Brown RA, Shantsila E, Varma C, Lip GY. Current understanding of atherogenesis. Am J Med 2017;130:268-282.
29. Sadat U, Jaffer FA, van Zandvoort MA, Nicholls SJ, Ribatti D, Gillard JH. Inflammation and neovascularization intertwined in atherosclerosis: imaging of structural and molecular imaging targets. Circulation 2014;130:786-794.
30. Hansson GK, Hermansson A. The immune system in atherosclerosis. Nat Immunol 2011;12:204-212.
31. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685-1695.
32. Sattur S, Sarwar B, Sacchi TJ, Brener SJ. Correlation between markers of reperfusion and mortality in ST-elevation myocardial infarction: a systematic review. J Invasive Cardiol 2014;26:587-595.
33. Sezer M, van Royen N, Umman B, Bugra Z, Bulluck H, Hausenloy DJ, Umman S. Coronary microvascular injury in reperfused acute myocardial infarction: a view from an integrative perspective. J Am Heart Assoc 2018;7:e009949.
34. Aurigemma C, Scalone G, Tomai F, Altamura L, De Persio G, Stazi A, Lanza GA, Crea F. Persistent enhanced platelet activation in patients with acute myocardial infarction and coronary microvascular obstruction: clinical implications. Thromb Haemost 2014;111:122-130.
35. Ziegler M, Wang X, Peter K. Platelets in cardiac ischaemia/reperfusion injury: a promising therapeutic target. Cardiovasc Res 2019;115:1178-1188.
36. Kohler D, Straub A, Weissmuller T, Faigle M, Bender S, Lehmann R, Wendel HP, Kurz J, Walter U, Zacharowski K, Rosenberger P. Phosphorylation of vasodilator-stimulated phosphoprotein prevents platelet-neutrophil complex formation and dampens myocardial ischemia-reperfusion injury. Circulation 2011;123:2579-2590.
37. Niccoli G, Montone Rocco A, Ibanez B, Thiele H, Crea F, Heusch G, Bulluck H, Hausenloy Derek J, Berry C, Stiermaier T, Camici Paolo G, Eitel I. Optimized treatment of ST-elevation myocardial infarction. Circ Res 2019;125:245-258.
| Files | ||
| Issue | Vol 16 No 4 (2021): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v16i4.8600 | |
| Keywords | ||
| Myocardial infarction No-reflow phenomenon Coronary artery disease Percutaneous coronary intervention Neutrophils Lymphocytes Blood platelets | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Rostami A, Tajlil A, Separham A, Sohrabi B, Pourafkari L, Roshanravan N, Aslanabadi N, Ziaee M, Mashayekhi S, Ghaffari S. Association between Neutrophil-to-Lymphocyte Ratio and the Systemic Inflammatory Immunologic Index and the Angiographic SYNTAX Score and the TIMI Flow Grade in Acute STEMI: A Cohort Study. J Tehran Heart Cent. 2021;16(4):147-155.
