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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.

Kurtul A, Murat SN, Yarlioglues M, Duran M, Celik IE, Kilic A, Ocek AH - Clinics (Sao Paulo) (2015)

Bottom Line: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention.Blood samples were drawn immediately upon hospital admission.The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

ABSTRACT

Objectives: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention.

Methods: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline.

Results: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio.

Conclusions: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

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Related in: MedlinePlus

Receiver operating characteristic (ROC) curve analysis of the use of neutrophil-to-lymphocyte ratio (NLR) values for predicting persistent coronary no-flow after wire insertion (AWI) (AUC 0.801, 95% CI 0.765-0.837).
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f2-cln_70p34: Receiver operating characteristic (ROC) curve analysis of the use of neutrophil-to-lymphocyte ratio (NLR) values for predicting persistent coronary no-flow after wire insertion (AWI) (AUC 0.801, 95% CI 0.765-0.837).

Mentions: The baseline angiographic and procedural characteristics of the study population are presented in Table 3. The number of diseased vessels and the prevalence of multivessel disease were similar among the groups (p = 0.252 and p = 0.277, respectively). The IFAs of patients with TIMI flow grade 1-3 AWI were less frequently located in the left anterior descending coronary artery, whereas in patients with baseline TIMI flow grade 0, the culprit lesions were more commonly located in the right coronary artery (p = 0.024). TIMI flow grade 0 was present before PPCI in 51.9% (n = 334) of infarct vessels and suboptimal flow (TIMI flow grade 1-2) was found in 25.0% (n = 161), whereas the remainder of infarct arteries presented with TIMI flow grade 3. As shown in Table 3, a final TIMI flow grade of 3 was achieved in 56.2% (n = 104) of patients with TIMI flow grade 0 AWI and in 87.8% (n = 122) of patients with TIMI flow grade 1-3 AWI; the remainder of patients had TIMI flow grade 1-3 at baseline. However, patients with TIMI flow grade 0 with persistent coronary no-flow after passage of the wire had a significantly lower prevalence of stent implantation, a lower rate of direct stenting, a higher total stent length and higher rate of balloon predilatation compared with those with TIMI flow grade 1-3 AWI and TIMI flow grade 1-3 at baseline (p<0.001 in post hoc analysis) (Table 3). Additionally, patients presenting with TIMI flow grade 0 had a significantly higher prevalence of tirofiban use compared with those with TIMI flow grade 1-3 at baseline (p = 0.006 in post hoc analysis). The multivariate logistic regression analysis showed that persistent coronary no-flow (TIMI 0) AWI was independently associated with the NLR (OR 1.421, 95% CI 1.274-1.585, p<0.001), peak CK-MB (OR 1.004, 95% CI 1001-1.007, p = 0.005) and the Syntax score (OR 1.058, 95% CI 1.021-1.096, p = 0.002) (Table 4). In the ROC curve analysis, an NLR>4.34 independently predicted TIMI flow 0 AWI, with 72% sensitivity and 70% specificity (AUC 0.801, 95% CI 0.765-0.837) (Figure 2). We also found that an NLR>4.34 was independently associated with the Syntax score (OR 1.035, p = 0.004), no-flow (OR 3.044, p<0.001) and peak CK-MB (OR 1.003, p = 0.001).


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.

Kurtul A, Murat SN, Yarlioglues M, Duran M, Celik IE, Kilic A, Ocek AH - Clinics (Sao Paulo) (2015)

Receiver operating characteristic (ROC) curve analysis of the use of neutrophil-to-lymphocyte ratio (NLR) values for predicting persistent coronary no-flow after wire insertion (AWI) (AUC 0.801, 95% CI 0.765-0.837).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4321001&req=5

f2-cln_70p34: Receiver operating characteristic (ROC) curve analysis of the use of neutrophil-to-lymphocyte ratio (NLR) values for predicting persistent coronary no-flow after wire insertion (AWI) (AUC 0.801, 95% CI 0.765-0.837).
Mentions: The baseline angiographic and procedural characteristics of the study population are presented in Table 3. The number of diseased vessels and the prevalence of multivessel disease were similar among the groups (p = 0.252 and p = 0.277, respectively). The IFAs of patients with TIMI flow grade 1-3 AWI were less frequently located in the left anterior descending coronary artery, whereas in patients with baseline TIMI flow grade 0, the culprit lesions were more commonly located in the right coronary artery (p = 0.024). TIMI flow grade 0 was present before PPCI in 51.9% (n = 334) of infarct vessels and suboptimal flow (TIMI flow grade 1-2) was found in 25.0% (n = 161), whereas the remainder of infarct arteries presented with TIMI flow grade 3. As shown in Table 3, a final TIMI flow grade of 3 was achieved in 56.2% (n = 104) of patients with TIMI flow grade 0 AWI and in 87.8% (n = 122) of patients with TIMI flow grade 1-3 AWI; the remainder of patients had TIMI flow grade 1-3 at baseline. However, patients with TIMI flow grade 0 with persistent coronary no-flow after passage of the wire had a significantly lower prevalence of stent implantation, a lower rate of direct stenting, a higher total stent length and higher rate of balloon predilatation compared with those with TIMI flow grade 1-3 AWI and TIMI flow grade 1-3 at baseline (p<0.001 in post hoc analysis) (Table 3). Additionally, patients presenting with TIMI flow grade 0 had a significantly higher prevalence of tirofiban use compared with those with TIMI flow grade 1-3 at baseline (p = 0.006 in post hoc analysis). The multivariate logistic regression analysis showed that persistent coronary no-flow (TIMI 0) AWI was independently associated with the NLR (OR 1.421, 95% CI 1.274-1.585, p<0.001), peak CK-MB (OR 1.004, 95% CI 1001-1.007, p = 0.005) and the Syntax score (OR 1.058, 95% CI 1.021-1.096, p = 0.002) (Table 4). In the ROC curve analysis, an NLR>4.34 independently predicted TIMI flow 0 AWI, with 72% sensitivity and 70% specificity (AUC 0.801, 95% CI 0.765-0.837) (Figure 2). We also found that an NLR>4.34 was independently associated with the Syntax score (OR 1.035, p = 0.004), no-flow (OR 3.044, p<0.001) and peak CK-MB (OR 1.003, p = 0.001).

Bottom Line: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention.Blood samples were drawn immediately upon hospital admission.The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey.

ABSTRACT

Objectives: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention.

Methods: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline.

Results: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio.

Conclusions: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Show MeSH
Related in: MedlinePlus