Monocyte/high-density lipoprotein cholesterol ratio is superior to neutrophil/lymphocyte ratio in the prediction of 3-month overall death in patients with acute ST-elevation myocardial infarction treated with percutaneous coronary intervention

Year 2019, Volume: 10 Issue: 4, 459 - 466, 31.12.2019

Erdoğan Sökmen Mustafa Çelik

https://doi.org/10.18663/tjcl.541023

Cited By: 1

Abstract

Aim: Although 30-day mortality rates were improved in the
setting of acute ST-elevation myocardial infarction (STMI), the same does not
hold true for longer-term mortality rates. The ratios of monocyte to
high-density lipoprotein cholesterol (MHR) and neutrophil to lymphocyte (NLR)
are novel markers with diagnostic and prognostic significance in various
disease conditions. Our aim was to evaluate the predictive role of MHR and NLR
in in-hospital and 3-month overall death in STMI patients treated with percutaneous
coronary intervention (PCI). 

Material and Methods: A total of 184 consecutive STMI patients undergoing
PCI were included. NLR, MHR, clinical and demographic characteristics, and
syntax scores were recorded. The patients were divided into two groups
according to the median MHR (group 1, n=92; group 2, n=92). In-hospital and
3-month overall death were noted as the primary outcome.

Results: Median MHR was 19.31. In-hospital mortality and 3-month mortality occurred in 14 (15.2%)
and 21 (22.8%) patients, respectively. NLR and number of the patients with
cardiogenic shock on admission were greater in group 2. No mortality occurred
in group 1. In multivariate logistic regression analysis, higher low-density
lipoprotein cholesterol level, higher syntax score and MHR, but not NLR, were
independently associated both with in-hospital and 3-month overall death. In
ROC analysis, MHR >36.6 and MHR >46.81 emerged as cut-off values for
in-hospital and 3-month mortality, respectively.

Conclusion: MHR but not NLR may be utilized in the prediction of
in-hospital and 3-month overall death in acute STMI patients treated with
primary PCI. 

Keywords

monocyte to HDL ratio, neutropil to lymphocyte ratio, mortality

Monosit/Yüksek-yoğunluklu lipoprotein kolesterol oranının, perkütan koroner girişim uygulanan akut st-elevasyonlu miyokard enfarktüsü hastalarında 3- aylık mortaliteyi öngördürmede nötrofil/lenfosit oranına üstünlüğü

Abstract

Amaç: Akut ST-elevasyonlu
miyokard enfarktüsünde (STME) 30-günlük mortalite oranlarında iyileştirme
sağlanabilmiş olmasına rağmen, aynı durum daha uzun sureli mortalite
oranlarında sağlanamamıştır. Monosit/yüksek yoğunluklu lipoprotein kolesterol
(MHO) ve nötrofil/lenfosit (NLO) oranları, çeşitli hastalık durumlarında
prognostik ve tanısal öneme sahip yeni belirteçler arasındadır. Bu çalışmadaki
amacımız, MHO ve NLO’nun perkütan koroner girişim (PKG) uygulanmış akut STME
hastalarında hastane içi ve 3 aylık mortaliteyi öngördürücü rolünü
değerlendirmektir.

Gereç ve Yöntemler: Çalışmaya PKG
uygulanmış toplam 184 STME hastası dahil edildi.  Hastalara ait NLO, MHO, klinik ve demografik
özellikler ile Syntax skorları kaydedilmiş olup hastalar medyan MHO
değerlerinde göre iki gruba ayrıldı (grup 1: 92 hasta; grup 2: 92 hasta). Hastane içi ve 3 aylık mortalite
oranları birincil sonlanım noktası olarak kaydedildi.

Bulgular:
Medyan MHO 19,31 olarak hesaplandı. Hastane içi
ve 3 aylık mortalite sırasıyla 14 (%15,2) ve 21 (%22,8) hastada gerçekleşti.
NLO ve kardiyojenik şok ile başvuru, grup 2’de anlamlı olarak daha yüksek
bulundu. Grup 1’de hiçbir hastada mortalite gelişmedi.  Çok değişkenli lojistik regresyon analizinde
yüksek düşük-yoğunluklu lipoprotein kolesterol düzeyinin, yüksek Syntax skorunun
ve yüksek MHO’nun, hastane içi ve 3 aylık mortalite ile bağımsız ilişkiye sahip
olduğu tespit edildi. Fakat aynı ilişki NLO ile gösterilemedi. ROC analizine
göre hastane içi ve 3 aylık mortaliteyi öngördüren MHO kestirim değerleri
sırasıyla >36,6 ve >46,81 bulundu.

Sonuç:
PKG uygulanmış
akut STME hastalarında MHO, hastane içi ve 3 aylık mortaliteyi öngördürmede
fayda sağlayabilmekte iken aynı fayda NLO ile sağlanamamaktadır.

Keywords

monosit/HDL oranı, nötrofil/lenfosit oranı, mortalite

References

• 1. Roger VL, Weston SA, Gerber Y, Killian JM, Dunlay SM, Jaffe AS, et al. Trends in incidence, severity, and outcome of hospitalized myocardial infarction. Circulation. 2010;121(7):863-9.
• 2. Tu JV, Austin PC, Filate WA, Johansen HL, Brien SE, Pilote L, et al. Outcomes of acute myocardial infarction in Canada. Can J Cardiol. 2003;19(8):893-901.
• 3. Tu JV, Donovan LR, Lee DS, Wang JT, Austin PC, Alter DA, et al. Effectiveness of public report cards for improving the quality of cardiac care: the EFFECT study: a randomized trial. JAMA. 2009;302(21):2330-7.
• 4. Aydın İ, Gökhan, Ş , Şener, A , Tanrıverdi, F , Pamukçu Günaydın, G , Kurtoğlu Çelik, G . (2018). Akut Koroner Sendromlu Hastalarda Nötrofil/Lenfosit Oranı ve Monosit Sayımının Değerlendirilmesi. Ankara Medical Journal, 18 (3), 345-354. DOI: 10.17098/amj.461436.
• 5. Wang Q, Meng Y, Cao W, Du W, Liu Y, Yan Y, et al. Association of monocyte to high-density lipoprotein cholesterol ratio with carotid artery intima-media thickness in patients with systemic lupus erythematosus. Biomarkers in medicine. 2018;12(4):359-64.
• 6. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45(10):1638-43.
• 7. Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis. 2012;225(2):456-60.
• 8. Cho KH, Jeong MH, Ahmed K, Hachinohe D, Choi HS, Chang SY, et al. Value of early risk stratification using hemoglobin level and neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol. 2011;107(6):849-56.
• 9. Cicek G, Kundi H, Bozbay M, Yayla C, Uyarel H. The relationship between admission monocyte HDL-C ratio with short-term and long-term mortality among STEMI patients treated with successful primary PCI. Coronary artery disease. 2016;27(3):176-84.
• 10. Olivares R, Ducimetiere P, Claude JR. Monocyte count: a risk factor for coronary heart disease? American journal of epidemiology. 1993;137(1):49-53.
• 11. Tabas I, Lichtman AH. Monocyte-Macrophages and T Cells in Atherosclerosis. Immunity. 2017;47(4):621-34.
• 12. Hafiane A, Genest J. High density lipoproteins: Measurement techniques and potential biomarkers of cardiovascular risk. BBA clinical. 2015;3:175-88.
• 13. Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol. 2014;46(8):1619-25.
• 14. Yayla KG, Canpolat U, Yayla C, Akboga MK, Akyel A, Akdi A, et al. A Novel Marker of Impaired Aortic Elasticity in Never Treated Hypertensive Patients: Monocyte/High-Density Lipoprotein Cholesterol Ratio. Acta Cardiol Sin. 2017;33(1):41-9.
• 15. Cagdas M, Karakoyun S, Yesin M, Rencuzogullari I, Karabag Y, Uluganyan M, et al. The Association between Monocyte HDL-C Ratio and SYNTAX Score and SYNTAX Score II in STEMI Patients Treated with Primary PCI. Acta Cardiol Sin. 2018;34(1):23-30.
• 16. You S, Zhong C, Zheng D, Xu J, Zhang X, Liu H, et al. Monocyte to HDL cholesterol ratio is associated with discharge and 3-month outcome in patients with acute intracerebral hemorrhage. Journal of the neurological sciences. 2017;372:157-61.
• 17. Balta S, Celik T, Ozturk C, Kaya MG, Aparci M, Yildirim AO, et al. The relation between monocyte to HDL ratio and no-reflow phenomenon in the patients with acute ST-segment elevation myocardial infarction. Am J Emerg Med. 2016;34(8):1542-7.
• 18. Karatas MB, Canga Y, Ozcan KS, Ipek G, Gungor B, Onuk T, et al. Monocyte to high-density lipoprotein ratio as a new prognostic marker in patients with STEMI undergoing primary percutaneous coronary intervention. Am J Emerg Med. 2016;34(2):240-4.
• 19. Zhang Y, Li S, Guo YL, Wu NQ, Zhu CG, Gao Y, et al. Is monocyte to HDL ratio superior to monocyte count in predicting the cardiovascular outcomes: evidence from a large cohort of Chinese patients undergoing coronary angiography. Annals of medicine. 2016;48(5):305-12.
• 20. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Circulation. 2012;126(16):2020-35.
• 21. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999;341(9):625-34.
• 22. van den Akker JPC, Bakker J, Groeneveld ABJ, den Uil CA. Risk indicators for acute kidney injury in cardiogenic shock. Journal of critical care. 2019;50:11-6.
• 23. Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA, Doppler Quantification Task Force of the N, et al. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15(2):167-84.
• 24. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77.
• 25. Rasoul S, Ottervanger JP, de Boer MJ, Dambrink JH, Hoorntje JC, Marcel Gosselink AT, et al. Predictors of 30-day and 1-year mortality after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Coronary artery disease. 2009;20(6):415-21.
• 26. Fan J, Watanabe T. Inflammatory reactions in the pathogenesis of atherosclerosis. Journal of atherosclerosis and thrombosis. 2003;10(2):63-71.
• 27. Yang RH, Liu YF, Wang XJ, Liang JG, Liu JC. Correlation between high density lipoprotein and monocyte subpopulations among stable coronary atherosclerotic heart disease patients. International journal of clinical and experimental medicine. 2015;8(9):16969-77.
• 28. Ou H, Huang Z, Mo Z, Xiao J. The Characteristics and Roles of Advanced Oxidation Protein Products in Atherosclerosis. Cardiovascular toxicology. 2017;17(1):1-12.
• 29. Zhang Y, Zanotti I, Reilly MP, Glick JM, Rothblat GH, Rader DJ. Overexpression of apolipoprotein A-I promotes reverse transport of cholesterol from macrophages to feces in vivo. Circulation. 2003;108(6):661-3.
• 30. Barter PJ, Nicholls S, Rye KA, Anantharamaiah GM, Navab M, Fogelman AM. Antiinflammatory properties of HDL. Circ Res. 2004;95(8):764-72.
• 31. Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459-72.
• 32. Yang H, Mohamed AS, Zhou SH. Oxidized low density lipoprotein, stem cells, and atherosclerosis. Lipids in health and disease. 2012;11:85.
• 33. Arruda-Olson AM RG, Bell MR, Weston SA, Roger VL. Neutrophilia predicts death and heart failure after myocardial infarction: a community-based study. Circ Cardiovasc Qual Outcomes. 2009;2(6):656-62.
• 34. Dragu R, Khoury S, Zuckerman R, Suleiman M, Mutlak D, Agmon Y, et al. Predictive value of white blood cell subtypes for long-term outcome following myocardial infarction. Atherosclerosis. 2008;196(1):405-12.
• 35. Canpolat U, Aytemir K, Yorgun H, Sahiner L, Kaya EB, Cay S, et al. The role of preprocedural monocyte-to-high-density lipoprotein ratio in prediction of atrial fibrillation recurrence after cryoballoon-based catheter ablation. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2015;17(12):1807-15.
• 36. Ulus T, Isgandarov K, Yilmaz AS, Uysal S, Vasi I, Dural M, et al. Monocyte to High-Density Lipoprotein Ratio Predicts Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome. Angiology. 2018;69(10):909-16.
• 37. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol. 2006;97(7):993-6.