The relationship between neutrophil percentage-to-albumin ratio and infarct related artery patency in patients with acute coronary syndrome

Year 2025, Volume: 8 Issue: 2, 333 - 337, 21.03.2025

Alkame Akgümüş , Ali Duygu , Ahmet Balun

https://doi.org/10.32322/jhsm.1615413

Abstract

Aims: One of the leading causes of death and disease burden globally is coronary heart disease (CHD). The primary cause of acute coronary syndrome (ACS) is atherosclerotic plaque rupture and thrombus development. The prognosis of ACS patients is also linked to atherosclerotic plaques, inflammatory cell infiltration (lymphocytes, monocytes, and neutrophils), and inflammation indicators. Low serum albumin (SA) levels have been linked to death in ACS patients in earlier research. In our study, we aimed to investigate the association of neutrophil percentage-to-albumin ratio (NPAR) with infarct-related adverse cardiac events (MACE) and infarct-related coronary artery patency (IRA).
Methods: The NPAR ratio was calculated based on the past laboratory findings of patients admitted with ACS who underwent coronary angiography (CAG), which were registered in the data system at the time of admission. A total of 87 patients were included in the study. Of these patients, 62 (71%) were non-patent and 25 (29%) were patent IRA patients.
Results: NPAR was significantly higher in the non-patent group (19.22±3.14 and 17.14±2.78 p=0.004). In multivariable logistic regression analysis, NPAR [p=0.027, odds ratio (OR): 0.787, 95% confidence intervals (CIs): 0.637-0.974] levels were found to be independent predictors of patent IRA. As revealed by the ROC curve analysis, the cut-off value of 17.88 for NPAR predicted the non-patent IRA with a sensitivity of 64% and specificity of 64% (AUC: 0.681; CIs: 0.588-0.809; p=0.008) NPAR was significantly higher in the MACE group (22.83±3.85 and 17.95±2.49 p<0.001).
Conclusion: In conclusion, inflammatory markers have been and are being used as predictive parameters for cardiovascular diseases in many studies. In our study, we focused on neutrophils and albumin. These findings revealed that NPAR is a independent predictor of IRA patency and long term mortality. We also indicated that NPAR may have a predictive role for mortality in the long-term follow-up of ACS patients.

Keywords

Neutrophil, albumin, infarct related artery, acute coronary syndrome

Akut koroner sendromlu hastalarda nötrofil yüzdesi/albumin oranı ile infakrt ilişkili arter açıklığı arasındaki ilişki

Abstract

Giriş: Dünya genelinde ölüm ve hastalık yükünün önde gelen nedenlerinden biri koroner kalp hastalığıdır (KKH). AKS'nin birincil nedeni aterosklerotik plak rüptürü ve trombüs gelişimidir. AKS hastalarının prognozu ayrıca aterosklerotik plaklar, enflamatuar hücre infiltrasyonu (lenfositler, monositler ve nötrofiller) ve enflamasyon göstergeleri ile bağlantılıdır. Daha önceki araştırmalarda düşük serum albümin düzeyleri AKS hastalarında ölümle ilişkilendirilmiştir. Çalışmamızda, NPAR'ın infarktla ilişkili advers kardiyak olaylar (MACE) ve infarktla ilişkili koroner arter açıklığı (IRA) ile ilişkisini araştırmayı amaçladık.
Yöntem: NPAR oranı, xxx Eğitim ve Araştırma Hastanesi'ne AKS ile başvuran ve koroner anjiyografi (KAG) yapılan hastaların başvuru sırasında veri sisteminde kayıtlı olan geçmiş laboratuvar bulgularına dayanarak hesaplandı. Çalışmaya toplam 87 hasta dahil edilmiştir. Bu hastaların 62'si (%71) patent olmayan ve 25'i (%29) patent IRA hastasıydı.
Sonuçlar: NPAR patenti olmayan grupta anlamlı olarak daha yüksekti (19.223.14 ve 17.142.78 p=0.004). Çok değişkenli lojistik regresyon analizinde, NPAR (p= 0.027, Odds Oranı (OR): 0.787, %95 Güven Aralığı CIs: 0.637-0.974) düzeylerinin patent IRA'nın bağımsız öngördürücüleri olduğu bulunmuştur.

Keywords

nötrofil, albümin, enfarkt ilişkili arter, akut koroner sendrom

References

• Kao DD, Ferrandino RM, Roof SA, et al. Neutrophil-to-lymphocyte ratio as a predictor of surgical outcomes in head and neck cancer. Head Neck. 2023;45(8):1903-1912. doi:10.1002/HED.27402
• Hay SI, Abajobir AA, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1260-1344. doi:10.1016/S0140-6736(17)32130-X
• Ji Z, Liu G, Guo J, et al. The neutrophil-to-lymphocyte ratio is an important indicator predicting in-hospital death in AMI patients. Front Cardiovasc Med. 2021;8. doi:10.3389/FCVM.2021.706852
• Ishida S, Hashimoto I, Seike T, Abe Y, Nakaya Y, Nakanishi H. Serum albumin levels correlate with inflammation rather than nutrition supply in burns patients: a retrospective study. J Med Invest. 2014;61(3-4):361-368. doi:10.2152/JMI.61.361
• Oduncu V, Erkol A, Karabay CY, et al. The prognostic value of serum albumin levels on admission in patients with acute ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Coron Artery Dis. 2013;24(2):88-94. doi:10.1097/MCA.0B013E32835C46FD
• Cui H, Ding X, Li W, Chen H, Li H. The neutrophil percentage to albumin ratio as a new predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction. Med Sci Monit. 2019; 25:7845-7852. doi:10.12659/MSM.917987
• Sun T, Shen H, Guo Q, et al. Association between neutrophil percentage-to-albumin ratio and all-cause mortality in critically ill patients with coronary artery disease. Biomed Res Int. 2020;2020. doi:10.1155/2020/ 8137576
• Kaya MG. Inflammation and coronary artery disease: as a new biomarker neutrophil/lymphocyte ratio. Turk Kardiyol Dern Ars. 2013; 41(3):191-192. doi:10.5543/TKDA.2013.84484
• Ylmaz S, Canpolat U, Baer K, Unal S, Kuyumcu MS, Aydodu S. Neutrophil-to-lymphocyte ratio predicts functionally significant coronary artery stenosis in patients with stable coronary artery disease. Turk Kardiyol Dern Ars. 2018;46(2):129-135. doi:10.5543/TKDA.2017. 16709
• Eckart A, Struja T, Kutz A, et al. Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: a prospective study. Am J Med. 2020;133(6):713-722.e7. doi:10.1016/J.AMJMED.2019.10.031
• Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med. 2016;9:229-255. doi:10.2147/IJGM.S102819
• González-Pacheco H, Amezcua-Guerra LM, Sandoval J, et al. Prognostic implications of serum albumin levels in patients with acute coronary syndromes. Am J Cardiol. 2017;119(7):951-958. doi:10.1016/J.AMJCARD.2016.11.054
• Kurtul A, Ocek AH, Murat SN, et al. Serum albumin levels on admission are associated with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Angiology. 2015;66(3):278-285. doi:10.1177/ 0003319714526035
• Gong Y, Li D, Cheng B, Ying B, Wang B. Increased neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with severe sepsis or septic shock. Epidemiol Infect. 2020;148. doi:10.1017/S0950268820000771
• Wang B, Li D, Cheng B, Ying B, Gong Y. The neutrophil percentage-to-albumin ratio is associated with all-cause mortality in critically ill patients with acute kidney injury. Biomed Res Int. 2020;2020. doi:10. 1155/2020/5687672
• Yu Y, Liu Y, Ling X, et al. The Neutrophil percentage-to-albumin ratio as a new predictor of all-cause mortality in patients with cardiogenic shock. Biomed Res Int. 2020;2020. doi:10.1155/2020/7458451
• Cai C, Zhang B, Sun T, et al. Neutrophil percentage to albumin ratio was associated with clinical outcomes in coronary care unit patients. Rev Cardiovasc Med. 2022;23:10. doi:10.31083/j.rcm2310333
• Cui H, Ding X, Li W, Chen H, Li H. The neutrophil percentage to albumin ratio as a new predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction. Medical Science Monitor. 2019;25:7845-7852. doi:10.12659/MSM.917987
• Lamas GA, Flaker GC, Mitchell G, et al. Effect of infarct artery patency on prognosis after acute myocardial infarction. The survival and ventricular enlargement investigators. Circulation. 1995;92(5):1101-1109. doi:10.1161/01.CIR.92.5.1101
• Mehta RH, Harjai KJ, Cox D, et al. Clinical and angiographic correlates and outcomes of suboptimal coronary flow in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol. 2003;42(10):1739-1746. doi:10.1016/j.jacc.2003.07.012
• Dogan M, Akyel A, Bilgin M, et al. Can admission neutrophil to lymphocyte ratio predict infarct-related artery patency in st-segment elevation myocardial infarction. Clin Appl Thromb Hemost. 2015;21(2): 172-176. doi:10.1177/1076029613515071
• Maden O, Kacmaz F, Selcuk MT, et al. Relationship of admission haematological indices with infarct-related artery patency in patients with acute ST-segment elevation myocardial infarction treated with primary angioplasty. Coron Artery Dis. 2007;18(8):639-644. doi:10.1097/MCA.0B013E3282F0EECB
• Acet H, Ertaş F, Akıl MA, et al. Novel predictors of infarct-related artery patency for ST-segment elevation myocardial infarction: platelet-to-lymphocyte ratio, uric acid, and neutrophil-to-lymphocyte ratio. Anatol J Cardiol. 2015;15(8):648-656. doi:10.5152/AKD.2014.5592