Subclinical Inflammation As an Independent Risk Factor for All-Cause Mortality in Patients with Left Main Coronary Artery Disease

Yıl 2022, Cilt: 25 Sayı: 1, 14 - 22, 18.04.2022

Kadriye Memiç Sancar Serkan Kahraman Seda Tükenmez Karakurt Meltem Tekin Büşra Çörekcioğlu Alkım Ateşli Hulusi Satılmışoğlu Gökhan Demirci Mustafa Yıldız

Öz

Introduction: This study aimed to investigate pre-procedural (Neutrophil to Lymphocyte Ratio) (NLR) in patients with (Left Main Coronary Artery) (LMCA) disease and to identify a relevant NLR value related to mortality after percutaneous intervention in unprotected LMCA disease.

Patients and Methods: Seventy-one patients diagnosed with unprotected LMCA disease were divided into two groups according to their mortality rates: survivors (n= 56, 78%) and non-survivors (n= 15, 22%). The mean follow-up duration was 26.0 ± 24.8 months, and all-cause mortality was considered as an endpoint.

Results: The non-survivor group had higher NLR values [3.23 (2.31-4.01) vs. 5.82 (2.92-14.99), p= 0.026] compared to the survivor-group. ROC analysis revealed an NLR cut-off value of 5.24 for predicting all-cause mortality. During follow-up, the group with high NLR values was associated with a significantly higher rate of all-cause mortality rate [6 (10.5%) vs. 9 (64.3%), p< 0.001] compared to the low NLR group. In multivariate analysis, the NLR (OR= 1.695; 95% CI= 1.124-2.556; p= 0.012) was found to be independent predictors of mortality.

Conclusion: NLR is the independent predictor of all-cause mortality in unprotected LMCA disease. As far as we know, this study is the first study investigating the prognostic value of NLR in patients with unprotected LMCA disease stenting.

Anahtar Kelimeler

Coronary artery disease, percutaneous coronary intervention, neutrophils, lymphocytes, mortality

Kaynakça

• 1. Katsiari CG, Bogdanos DP, Sakkas L. Inflammation and cardiovascular disease. World J Transl Med 2019;8(1):1-8. [Crossref]
• 2. Nunez J, Sanchis J, Bodí V, Núñez E, Mainar L, Heatta AM, et al. Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. ASVD 2009;206:251-7. [Crossref]
• 3. Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol 2000;86:449-51. [Crossref]
• 4. Benites-Zapata VA, Hernandez AV, Nagarajan V, Cauthen CA, Starling RC, Wilson Tang VH. Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure. Am J Cardiol 2015;115:57-61. [Crossref]
• 5. Bowen RC, Little NAB, Harmer JR, Ma J, Mirabelli LG, Roller KD, et al. Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis. Oncotarget 2017;8:32171-89. [Crossref]
• 6. Ethier JL, Desautels D, Templeton A, Shah PS, Amir E. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis, Breast Cancer Res 2017;19:2. [Crossref]
• 7. Salciccioli JD, Marshall DC, Pimentel MA, Santos MD, Pollard T, Celi LA, et al. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit Care 2015;19(1):13. [Crossref]
• 8. Boudriot E, Thiele H, Walther T, Liebetrau C, Boeckstegers P, Pohl T, et al. Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main artery stenosis. J Am Coll Cardiol 2011;57:538-45. [Crossref]
• 9. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines and the society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv 2012;79:453-95. [Crossref]
• 10. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. Euro-Intervention 2005;1:219-27.
• 11. Li X, Ji Y, Kang J, Fang N. Association between blood neutrophil-tolymphocyte ratio and severity of coronary artery disease: evidence from 17 observational studies involving 7017 cases. Medicine (Baltimore) 2018;97:e12432. [Crossref]
• 12. Wada H, Dohi T, Miyauchi K., Shitara J., Endo H, Doi S. et al. Pre-procedural neutrophil-to-lymphocyte ratio and long-term cardiac outcomes after percutaneous coronary intervention for stable coronary artery disease. Atherosclerosis 2017;265:35-40. [Crossref]
• 13. Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. 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;110:621-7. [Crossref]
• 14. Xu N, Tang X, Yao Y, Zhao X, Chen J, Gao Z, et al. Predictive value of neutrophil to lymphocyte ratio in long-term outcomes of left main and/or three-vessel disease in patients with acute myocardial infarction. Catheter Cardiovasc Interv 2018;91:551-7. [Crossref]
• 15. Ibañez B, James S, Agewall S, Antunes MJ, Ducci CB, 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;39:119-77. [Crossref]
• 16. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021;42(14):1289-367. [Crossref]
• 17. Killip T III, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967;20:457-64. [Crossref]
• 18. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The syntax score: an angiographic tool grading the complexity of coronary artery disease. Euro Intervention 2005;1(2):219-27.
• 19. Ragosta M, Dee S, Sarembock IJ, Lipson LC, Gimple LW, Powers ER. Prevalence of unfavorable angiographic characteristics for percutaneous intervention in patients with unprotected left main coronary artery disease. Catheter Cardiovasc Interv 2006;68:357. [Crossref]
• 20. Taggart DP, Kaul S, Boden WE, Ferguson Jr TB, Guyton RA, Mack MJ, et al. Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery. J Am Coll Cardiol 2008;51:885. [Crossref]
• 21. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961. [Crossref]
• 22. Conley MJ, Ely RL, Kisslo J, Lee KL, McNeer JF, Rosati RA. The prognostic spectrum of left main stenosis. Circulation 1978;57:947. [Crossref]
• 23. Kaya H, Ertaş F, İslamoğlu Y, Kaya Z, Atılgan ZA, Cil H, et al. Association between neutrophil to lymphocyte ratio and severity of coronary artery disease. Clin Appl Thromb Hemost 2014;20:50-4. [Crossref]
• 24. Sönmez O, Ertaş G, Bacaksız A, Taşal A, Erdoğan E, Asoğlu E, et al. Relation of neutrophil-to-lymphocyte ratio with the presence and complexity of coronary artery disease: an observational study. Anatol J Cardiol 2013;13:662-7. [Crossref]
• 25. Kaya A, Kurt M, Tanboğa IH, Işık T, Günaydın ZY, Kaya Y, et al. Relation of neutrophil to lymphocyte ratio with the presence and severity of stable coronary artery disease. Clin Appl Thromb Hemost 2014;20:473-7. [Crossref]
• 26. Park JJ, Jang HJ, Oh IY, Yoon CH, Suh JW, Cho YS, et al. Prognostic value of neutrophil to lymphocyte ratio inpatients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2013;111:636-42. [Crossref]
• 27. Arbel Y, Shacham Y, Ziv Baran T, Laufer Perl M, Finkelstein A, Halkin A, et al. Higher neutrophil/lymphocyte ratio is related to lower ejection fraction and higher long-termall-cause mortality in ST-elevation myocardial infarction patients. Can J Cardiol 2014;30:1177-82. [Crossref]
• 28. Kurtul A, Murat SN, Yarlioglues M, Duran M, Celik IE, Kilic A, et al. Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clinics (Sao Paulo) 2015;70:34-40. [Crossref]
• 29. Bressi E, Mangiacapra F, Ricottini E, Cavallari I, Colaiori I, Di Gioia G, et al. Impact of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on 5-year clinical outcomes of patients with stable coronary artery disease undergoing elective percutaneous coronary intervention. J Cardiovasc Transl Res 2018;11(6):517-23. [Crossref]
• 30. Sen N, Afsar B, Ozcan F, Buyukkaya E, Isleyen A, Akcay AB, et al. 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(1):203-10. [Crossref]
• 31. Parlar H, Şaşkın H. Are pre and postoperative platelet to lymphocyte ratio and neutrophil to lymphocyte ratio associated with early postoperative AKI following CABG? Braz J Cardiovasc Surg 2018;33(3):233-41. [Crossref]
• 32. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395:27-31. [Crossref]
• 33. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102:653-7. [Crossref]
• 34. Kaya MG, Akpek M, Lam YY, Yarlioglues M, Celik T, Gunebakmaz O, et al. Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention: a prospective, multicenter study. Int J Cardiol 2013;168(2):1154-9. [Crossref]
• 35. Kahraman S, Zencirkiran Agus H, Demirci G, Can C, Demir AR, Güner A, et al. The impact of coronary artery disease severity on long term outcomes in unprotected left main coronary artery revascularization. Turk Kardiyol Dern Ars 2021;49:8-21. [Crossref]
• 36. Sahin DY, Gür M, Elbasan Z, Özdoğru I, Uysal OK, Kivrak A, et al. Mean platelet volume and extent and complexity of coronary artery disease in diabetic and nondiabetic patients with ST elevation myocardial infarction. Angiology, 2013;64:505-11. [Crossref]
• 37. Pan W, Zhao D, Zhang C, Li W, Yu J, Wang S, et al. Application of neutrophil/lymphocyte ratio in predicting coronary blood flow and mortality in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. J Cardiol 2015;66:9-14. [Crossref]
• 38. Spark JI, Sarveswaran J, Blest N, Charalabidis P, Asthana S. An elevated neutrophil-lymphocyte ratio independently predicts mortality in chronic critical limb ischemia. J Vasc Surg 2010;52:632-6. [Crossref]
• 39. Gurbuz O, Kumtepe G, Ozkan H, Karal IH, Velioglu Y, Ercan A, et al. Predictive value of neutrophil-lymphocyte ratio for long-term cardiovascular event following coronary artery bypass grafting. Braz J Cardiovasc Surg 2020;35(3):274-84. [Crossref]
• 40. Karakas MS, Korucuk N, Tosun V, Altekin RE, Koc F, Ozbek SC, et al. Red cell distribution width andneutrophil-to-lymphocyte ratio predict left ventriculardysfunction in acute anterior ST-segment elevationmyocardial infarction. J Saudi Heart Assoc 2016;28:152-8. [Crossref]
• 41. Erkol A, Oduncu V, Turan B, Kiliçgedik A, Karabay CY, Akgün T, et al. Neutrophil to lymphocyte ratio in acute ST-segment elevation myocardial infarction. Am J Med Sci 2014;348:37-42. [Crossref]
• 42. Arruda-Olson AM, Reeder GS, Bell MR, Weston SA, Roger VL. Neutrophilia predicts death and heart failure aftermyocardial infarction: a community-based study. Circ Cardiovasc Qual Outcomes 2009;2:656-62. [Crossref]
• 43. Ertem AG, Ozcelik F, Kasapkara HA, Koseoglu C, Bastug S, Ayhan H et al. Neutrophil lymphocyte ratio as a predictor of left ventricular apical thrombus in patients with myocardial infarction. Korean Circ J 2016;46:768-73. [Crossref]
• 44. Gul U, Kayani AM, Munir R, Hussain S. Neutrophil lymphocyte ratio: a prognostic marker in acute ST elevation myocardial infarction. J Coll Phys Surg Pakistan 2017;27:4-7.
• 45. Ghaffari S, Nadiri M, Pourafkari L, Sepehrvand N, Movasagpoor A, Rahmatvand N, et al. The predictive valueof total neutrophil count and neutrophil/lymphocyte ratio in predicting in-hospital mortality and complications after STEMI. J Cardiovasc Thorac Res 2014;6:35-4. [Crossref]
• 46. Gazi E, Bayram B, Gazi S, Temiz A, Kirilmaz B, Altun B, et al. Prognostic value of the neutrophil-lymphocyte ratio inpatients with ST-elevated acute myocardial infarction. Clin Appl Thromb Hemost 2015;21:155-9. [Crossref]