Relationship between Neutrophil-to-Lymphocyte Ratio and Left Ventricular Free Wall Rupture in Acute Myocardial InfarctionIpek G.a · Onuk T.a · Karatas M.B.a · Güngör B.a · Atasoy I.a · Murat A.a · Aldag M.b · Yelgec N.S.a · Dayi S.U.a · Bolca O.a
Departments of aCardiology and bCardiovascular Surgery, Siyami Ersek Cardiothoracic Surgery Center, Istanbul, Turkey
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Objectives: This study aimed to evaluate the relationship between the neutrophil-to-lymphocyte (N/L) ratio and left ventricular free wall rupture (LVFWR) in patients with ST elevation myocardial infarction (STEMI). Previous studies showed a correlation between increased levels of inflammatory markers and adverse cardiovascular events. The role of inflammation markers, particularly the N/L ratio, in mechanical complications after myocardial infarction has not been studied. Methods: Retrospectively, we compared the N/L ratio values of 23 patients with STEMI complicated by LVFWR with 214 STEMI patients without this complication. The diagnosis of rupture was confirmed by echocardiography in each case. Results: Neutrophil counts [median 8.5 × 103/µl, interquartile range (IQR) 6.4, vs. 7.8 × 103/µl, IQR 4.7, p = 0.02] and the N/L ratio (5.66, IQR 4.17, vs. 4.1, IQR 3.93, p = 0.01) were significantly higher in the LVFWR group. In receiver operating characteristic analysis, an N/L ratio above 3.7 predicted LVFWR with a sensitivity of 82.6% and a specificity of 46.9% (area under the curve = 0.654, p = 0.016). In multivariate regression analysis, age, hypertension, increased creatinine levels and increased N/L ratio (odds ratio = 1.61, 95% confidence interval = 1.15-2.23, p = 0.01) were found to be independent predictors of LVFWR. Conclusions: In our study, the N/L ratio was found to be independently correlated with the risk of LVFWR.
© 2015 S. Karger AG, Basel
- Mandelzweig L, Battler A, Boyko V, et al; Euro Heart Survey Investigators: The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J 2006;27:2285-2293.
Khan MG: Heart Disease Diagnosis and Therapy: A Practical Approach. Berlin, Springer Science & Business Media, 2007.
- Pollak H, Nobis H, Mlczoch J: Frequency of left ventricular free wall rupture complicating acute myocardial infarction since the advent of thrombolysis. Am J Cardiol 1994;74:184-186.
- O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, 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.
- Figueras J, Alcalde O, Barrabes JA, Serra V, Alguersuari J, Cortadellas J, et al: Changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation 2008;118:2783-2789.
- Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, et al: ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569-2619.
- Park JJ, Jang HJ, Oh IY, Yoon CH, Suh JW, Cho YS, Choi DJ: Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2013;111:636-642.
- 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;110:621-627.
- Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al: 2013 ESH/ESC guidelines for the management of arterial hypertension. Eur Heart J 2013;34:2159-2219.
- American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2014;37(suppl 1):S81-S90.
Perrone C, Pasquetto G, Boschello M, Dovigo P, Marchiori MC, Galassi A, et al: Heart rupture in acute myocardial infarction: the advantages of using M-2D color Doppler echocardiography in a coronary intensive therapy unit. G Ital Cardiol 1999;29:662-668.
- Libby P, Ridker PM, Maseri A: Inflammation and atherosclerosis. Circulation 2002;9:1135-1143.
- Hansson GK: Inflammation, atherosclerosis and coronary artery disease. N Engl J Med 2005;352:1685-1695.
Topol EJ, Califf RM (eds): Textbook of Cardiovascular Medicine. Baltimore, Lippincott Williams & Wilkins, 2007, vol 355.
- Hochman JS, et al: Cardiogenic shock complicating acute myocardial infarction - etiologies, management and outcome: a report from the SHOCK Trial Registry. J Am Coll Cardiol 2000;36:1063-1070.
- Moreno R, Lopez-Sendon J, Garcia E, Perez de Isla L, Lopez de Sa E, Ortega A, et al: Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction. J Am Coll Cardiol 2002;39:598-603.
- Ikeda N, Yasu T, Kubo N, Hirahara T, Sugawara Y, Kobayashi N, et al: Effect of reperfusion therapy on cardiac rupture after myocardial infarction in Japanese. Circ J 2004;68:422-426.
- Anzai T, Yoshikawa T, Shiraki H, Asakura Y, Akaishi M, Mitamura H, et al: C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction. Circulation 1997;96:778-784.
- Widmer A, Linka AZ, Attenhofer Jost CH, Buergi B, Brunner-La Rocca HP, Salomon F, Seifert B, Jenni R: Mechanical complications after myocardial infarction reliably predicted using C-reactive protein levels and lymphocytopenia. Cardiology 2003;99:25-31.
- Shuster EH, Bulkley BH: Expansion of transmural myocardial infarction: a pathophysiologic factor in cardiac rupture. Circulation 1979;60:1532-1538.
- Richard V, Murry CE, Reimer KA: Healing of myocardial infarcts in dogs: effect of late reperfusion. Circulation 1995;92:1891-1901.
- Chia S, Nagurney JT, Brown DF, Raffel OC, Bamberg F, Senatore F, Jang IK: Association of leukocyte and neutrophil counts with infarct size, left ventricular function and outcomes after percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol 2009;103:333-337.
- Núñez J, Núñez E, Bodí V, et al: Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008;6:747-752.
- Kalay N, Dogdu O, Koc F, Yarlıoglues M, Ardic I, Akpek M, Kaya MG: Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology 2012;63:213-217.
- Sen N, Afsar B, Ozcan F, Buyukkaya E, Isleyen A, Akcay AB, 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.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.