Association Between Neutrophil To Lymphocyte Ratio And Severity Of Coronary Artery Disease In ACS

Objective: This research is to elucidate the relationship between(neutrophil to lymphocyte ratio, NLR) and the severity of coronary artery disease in acute coronary syndrome(ACS).Method: 351 patients were enrolled in the research who were admitted in Department of Cardiology, the Second Affiliated Hospital of Dalian Medical University and suspected to suffer from acute coronary syndromes from January 2014 to September2014. All patients enrolled accepted coronary angiography in hospital and related blood biochemical examination immediately or next morning after admission.According to the result of coronary angiography, 265 patients were divided into ACS group and 86 patients as control group. The ACS group was further divided into unstable angina pectoris group(UA group) with 119 cases, and acute myocardial infarction group(AMI group) with 146 cases. The diagnosis of ACS was consistent with the definition in latest diagnosis and treatment guidelines(2012-2013) of UA,NSTEMI and STEM proposed by American College of Cardiology Foundation(ACCF)and American Heart Association(AHA). We studied the the result of coronary angiography carefully and calculated Gensini score(GS). Through Tertile law we divided patients into 3 group according to GS(90 cases in low value group GS≤30,89 cases in median value group 30<GS<50, 89 cases in high value group GS≥50)and used SPSS 17 software for statistical analysis.Results:1. Compared with control group, patients in ACS group had a higher proportion of men, higher prevalence of hypertension, diabetes,smoking, an older age, higher Ddimers and lower high density lipoprotein and apolipoprotein A, the differences were all statistically significant(P < 0.05). White blood cell count, neutrophil count, and NLR were all increased significantly in ACS group compared with control group, and the differences were statistically significant(P < 0.05).2. Compared with control group, white blood cell count, neutrophil count, and NLR were increased in succession in UA group and AMI group, and the difference was statistically significant(P=0.000). Through multiple comparison of white blood cell count, neutrophil count, and NLR in UA group, AMI group and control group, we found that the difference between any two group was statistically significant. The difference of NLR was statistically significant between AMI group compared to UA group or control group, but not in comparison of UA group and control group.3. Analysis of variance in general clinical data of different GS groups found that the differences of age and cholesterol level were statistically significant with a P value of 0.003 and 0.011 respectively. Differences of white blood cell count, neutrophil count, lymphocytes count and NLR were all statistically significant(P=0.000) between different GS group. Further multiple comparison of above index in different GS groups found that: differences of white blood cell count, neutrophil count, and NLR were all statistically significant between any two GS groups.4. Through logistic regression analysis of risk factors of ACS and high GS, we found in addition to age, gender, diabetes prevalence and BMI. NLR is also independent risk factor of ACS(OR=1.528 95%CI:1.218-1.919 P=0.000). Meanwhile,NLR and age were independent risk factors of high GS patient(OR=1.604 95%CI1.218-1.919 P=0.000 and OR=1.305 95%CI 1.008-1.062 P=0.012).5. Through correlation analysis of white blood cell classification and NLR with high GS using Spearman and Pearson correlation analysis, we found that White blood cells were positively associated with high GS r=0.352 P=0.000, neutrophil was positively correlated with GS r=0.436 P=0.000, lymphocytes and high GS negatively correlated with r=-0.261 P=0.001, NLR was positively associated with high GS,r=0.552 P=0.000.6. Using ROC curve analysis of patients in high value GS group, we found that in diagnosis of high value GS group, NLR has the largest area under the curve of0.769(95% confidence interval 0.702-0.835, P=0.000) compared to WBC and its subtypes. NLR of 3.35 was the cut point for identification of high value GS group,with a specificity of 71.9% and a sensitivity of 81%.Conclusions: 1. Compared to control group, NLR is significantly higher in blood samples of patients with ACS. NLR is independent risk factor of ACS2. There is a positive correlation between NLR and GS in patients with ACS, NLR can predict coronary lesion severity independently.3. An NLR value above 3.35 indicates that a higher ACS risk and more severe coronary artery injury.