The Diagnostic Value of Hemogram Parameters for Myocardial Infarction in the Emergency Department

Öz

Aim We aimed to evaluate the diagnostic value of hemogram-based inflammatory parameters particularly leukocyte, leukocyte-to-platelet ratio, and neutrophil-to-platelet ratio in identifying myocardial infarction among patients presenting to the emergency department with chest pain. Materials and Methods: A total of 60 myocardial infarction and 60 non- myocardial infarction patients aged over 18 years who presented to the emergency department with chest pain between January and February 2025 were retrospectively analyzed. Hemogram, biochemistry, electrocardiography, and creatine kinase-MB values were evaluated. leukocyte, , leukocyte-to-platelet and neutrophil-to-platelet ratios were compared between the two groups. The discriminatory performance of these parameters was assessed using Receiver Operating Characteristic analysis, and optimal cutoff values were determined using the Youden index. Results: Glucose, creatine kinase-MB, leukocyte, neutrophil count leukocyte-to-platelet ratio, and neutrophil-to-platelet ratio levels were significantly higher in the myocardial infarction group compared with the control group (p<0.001). In Receiver Operating Characteristic analysis, leukocyte-to-platelet ratio demonstrated the highest diagnostic accuracy with an AUC of 0.732. The cutoff value for leukocyte-to-platelet ratio was 0.0365, yielding a sensitivity of 71.7% and specificity of 66.7%. The AUC values for neutrophil-to-platelet ratio and glucose were 0.674 and 0.672, respectively. Conclusion: Rapid, low-cost, and readily accessible parameters such as leukocyte, leukocyte-to-platelet ratio and neutrophil-to-platelet ratio were shown to have significant discriminatory value in diagnosing myocardial infarction. Particularly, the high diagnostic accuracy of leukocyte-to-platelet ratio, supports its potential use as a practical biomarker to assist clinical decision-making while awaiting troponin results.

Anahtar Kelimeler

• Myocardial infarction;
• leukocyte-to-platelet ratio;
• neutrophil-to-platelet ratio;
• leukocyte;
• emergency department

Acil Serviste Miyokard Enfarktüsünde Hemogram Parametrelerinin Tanısal Değeri

Öz

Amaç: Bu çalışmada, acil servise göğüs ağrısı ile başvuran hastalarda miyokard enfarktüsünün tanısında lökosit sayısı, lökosit-trombosit oranı ve nötrofil-trombosit oranı gibi hemogram temelli inflamatuvar parametrelerin tanısal değerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Ocak–Şubat 2025 tarihleri arasında acil servise göğüs ağrısı ile başvuran, 18 yaş üzeri 60 miyokard enfarktüslü ve 60 miyokard enfarktüsü olmayan hasta retrospektif olarak incelendi. Hemogram, biyokimya, elektrokardiyografi ve kreatin kinaz-MB değerleri değerlendirildi. Lökosit sayısı, lökosit-trombosit oranı ve nötrofil-trombosit oranı iki grup arasında karşılaştırıldı. Tanısal performans alıcı işletim karakteristiği analizi ile değerlendirildi ve optimal eşik değerler Youden indeksi kullanılarak belirlendi. Bulgular: Glukoz, kreatin kinaz-MB, lökosit sayısı, nötrofil sayısı, lökosit-trombosit oranı ve nötrofil-trombosit oranı miyokard enfarktüsü grubunda kontrol grubuna göre anlamlı derecede daha yüksek bulundu (p<0.001). Alıcı işletim karakteristiği analizinde, lökosit-trombosit oranı en yüksek tanısal doğruluğa sahip olup eğri altında kalan alan değeri 0.732 olarak saptandı. Bu parametre için kesim değeri 0.0365 olup duyarlılık %71.7 ve özgüllük %66.7 idi. Sonuç: Hızlı, düşük maliyetli ve kolay erişilebilir hemogram parametreleri miyokard enfarktüsünün tanısında anlamlı katkı sağlayabilir. Özellikle lökosit-trombosit oranı, troponin sonuçları beklenirken klinik karar verme sürecini destekleyebilecek pratik bir biyobelirteç olabilir.

Anahtar Kelimeler

• Miyokard enfarktüsü;
• lökosit-trombosit oranı;
• nötrofil-trombosit oranı;
• lökosit;
• acil servis

Kaynakça

1. 1. 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. Eur Heart J. 2018;39(2):119-177.
2. 2. Cevik Y. ST-segment elevation myocardial infarction. In: Cander B, editor. Emergency Medicine: Basic Reference Book. 2nd ed. Vol 1. Istanbul: Istanbul Medical Publishing; 2020. p. 573-580.
3. 3. Kekec Z, editor. Cardiovascular emergencies. In: Emergency Medicine: Diagnosis, Treatment and Practice. 2nd ed. Istanbul: Nobel Medical Publishing; 2011. p. 50.
4. 4. Shah R, Menon V. Acute myocardial infarction. In: Griffin BP, Menon V, editors. Manual of Cardiovascular Medicine. 6th ed. Philadelphia: Wolters Kluwer; 2024. p. 38.
5. 5. Babes EE, Zaha DC, Tit DM, Nechifor AC, Bungau S, Andronie-Cioara FL, et al. Value of hematological and coagulation parameters as prognostic factors in acute coronary syndromes. Diagnostics (Basel). 2021;11(5):850.
6. 6. Arbel Y, Finkelstein A, Halkin A, Birati E, Revivo M, Zuzut M, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease. Clin Cardiol. 2012;35(7):416-420.
7. 7. Zhao G, Gu Y, Chen Y, Xia X. Association of systemic inflammatory markers with outcomes in acute coronary syndrome. PLoS One. 2024;19(12):e0314872.
8. 8. Twerenbold R, Boeddinghaus J, Nestelberger T, Wildi K, Gimenez MR, Jaeger C, et al. Clinical use of high-sensitivity cardiac troponin in patients with suspected myocardial infarction. J Am Coll Cardiol. 2018;72(14):1584-1598. 9. Meng K, Lei L, He H. Association between serum inflammatory markers and cardiovascular outcomes: a clinical analysis. Sci Rep. 2024;14:79015.

9. 10. Halucha K, Rak-Pasikowska A, Bil-Lula I. Protective role of platelets in myocardial infarction and ischemia/reperfusion injury. Cardiol Res Pract. 2021;2021:5545416.
10. 11. Budzianowski J, Pieszko K, Burchardt P, Rzezniczak J, Hiczkiewicz J. The role of hematological indices in patients with acute coronary syndrome. Cardiol Res Pract. 2017;2017:3041565.
11. 12. Erturk M, Turhan Caglar FN, Biyik I, Yildiz A. Correlations between hematological indicators and biomarkers in acute coronary syndrome. Eur J Clin Med. 2017;5(2):67-72. 13. Tadesse S, Chen G, Xu B. Predictive role of hematological indices in acute coronary syndrome. Heliyon. 2024;10(2):e028216.
12. 14. Hassan NAE, et al. Platelet indices and blood cell ratios in acute coronary syndrome. Cardiovasc Med Res Pract. 2020;5(1):11-18.
13. 15. Wang H, Li J, Zhao P. Hematological parameters and early-onset coronary artery disease in ACS. Ther Adv Chronic Dis. 2023;14:1-12.
14. 16. Luke K, Mareta A, Andoko A. Predictive value of hematologic indices in ACS diagnosis. Open Access Maced J Med Sci. 2019;7(20):3417-3423.
15. 17. Bao Q, Liu T, Song H, Bao W, Fan W. Prognostic value of inflammatory hematologic indices in predicting acute coronary syndrome in elderly patients with chronic coronary syndrome. J Inflamm Res. 2025:9637-9653.
16. 18. Raghavendra UPV, et al. Significance of hematologic indices in ACS identification. Healthcare (Basel). 2024;14(3):294-299.
17. 19. Cicek G, Acikgoz SK, Yayla C, Kundi H, Ileri M. White blood cell count to mean platelet volume ratio: a novel prognostic marker for STEMI. Cardiol J. 2016;23(3):225-235. 20. Mohammed AA, Liu L, Mareai RM, Mohammed AQ, Yin G, Singh S, et al. Combined WBC/MPV ratio and neutrophil-to-platelet ratio predict long-term adverse events in MINOCA. Mediators Inflamm. 2022;2022:5642406.
18. 21. Liao J, Xiong F, Chen H, Li W, Zhang X, Gao H, et al. Neutrophil-to-platelet ratio predicts in-hospital mortality in acute myocardial infarction. Intern Emerg Med. 2025;20(3):723-731.
19. 22. Cheng SY, Wang H, Lin SH, Wen JH, Ma LL, Dai XC. Association of admission hyperglycemia with all-cause mortality in acute myocardial infarction undergoing PCI: a dose-response meta-analysis. Front Cardiovasc Med. 2022;9:932716.