Preprocedural Neutrophil To Lymphocyte Ratio Predıcts Coronary Artery Perforation.

Authors

  • Abdulmelik Yıldız Medical Park Hospital, Cardiology, Ä°stanbul
  • Cennet Yıldız
  • Fatih Tekiner
  • Bayram Bağırtan

Keywords:

Coronary Perforation, Neutrophil to Lymphocyte Ratio, Percutaneous Coronary Intervention

Abstract

Objectives: Coronary artery perforation is a rare, but potentially serious, complication of the percutaneous coronary intervention that can result in death.  Our aim is to define the parameters that show the CP risk before the coronary intervention. Neutrophil/lymphocyte ratio is a novel parameter for assessing inflammation. In this study, our aim is to evaluate the predictive value of NLR for coronary artery perforation.

Method and Results: We retrospectively reviewed 3542 patients who were performed percutaneous coronary intervention (PCI) in our clinic in the period between 2008 and 2012. The group I, consisted of 17 patients diagnosed with CP. The control group (group II) consisted of 358 patients implanted with bare metal stents (BMS) in the same period. The blood samples obtained from the patients prior to the procedure were tested  for NLR, C- reactive protein (CRP) and biochemical analysis. There was no statistically significant difference between the groups with regard to age, gender and vessel in which the procedure was done.

NLR and CRP levels were analyzed before percutanous coronary intervention (PCI). NLR and CRP levels in group I was significantly higher than that in group II (3.64±1.3 and 2.5±1.3 p<0.002; 4.1±1.3 and 2.8±1.1 p<0.01 respectively). Multivariate logistic regression analysis showed that NLR, CRP, neutrophil and LDL levels were independently predicted the coronary artery perforation. ROC curve analysis showed that NLR had a sensitivity of 76.5% and a specificity of 77.8% for predicting coronary perforation when the cut-off value of NLR was 3.05.

Conclusion: It has been demonstrated that NLR which are calculated from the whole blood count, a simple and cheap test, before the procedure statistically has a predictive value to anticipate CP.

References

Ross R. Atherosclerosis; an inflammatory disease. N Engl J Med. 1999;340(2):115-26

Lind L. Circulating markers of inflammation and atherosclerosis. Atherosclerosis. 2003;169(2):203-14.

Libby P, Ridker PM, Hansson GK. Leducq Transatlantic Network on atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54:2129-38.

Baetta R, Corsini A. Role of polymorphonuclear neutrophils in atherosclerosis: current state and future perspectives. Atherosclerosis. 2010;210:1-13.

Chandra P, Chatterjee S, Koradia N, et al. Predisposing factors, demographics, angiographic features, and the possible role of inflammation in coronary perforations. A 10-year single-center experience. Am Heart Hosp J. 2011; 9(2): 87-9

Harlan JM, Killen PD, Harker LA, et al. Neutrophil mediated endothelial injury in vitro mechanisms of cell detachment. The Journal of Clinical Investigation. 1981; 68(6):1394-403.

Sabatine MS, Morrow DA, Cannon CP, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 trial) substudy. J Am Coll Cardiol. 2002;40(10):1761-8.

Tamhane UU, Aneja S, Montgomery D, et al. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008;102(6):653-7.

Palmerini T, Marzocchi A, Marrozzini C, et al. Preprocedural levels of C-reactive protein and leukocyte counts predict 9-month mortality after coronary angioplasty for the treatment of unprotected left main coronary artery stenosis. Circulation. 2005;112(15):2332-8.

Wheeler JG, Mussolino ME, Gillum RF, et al. Associations between differential leucocyte count and incident coronary heart disease: 1764 incident cases from seven prospective studies of 30 374 individuals. Eur Heart J. 2004; 25(15):1287-92.

Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. A systematic review on more than 34.000 subjects. Thromb Haemost. 2011;106(4):591-9.

Grau AJ, Boddy AW, Dukovic DA, et al. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke. 2004;35(5):1147-52.

Ellis SG, Ajluni S, Arnold AZ, et al. Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation. 1994;90(6):2725-30.

Ajluni SC, Glazier S, Blankenship L, et al. Perforations after percutaneous coronary interventions: clinical, angiographic, and therapeutic observations. Cathet Cardiovasc Diagn. 1994;32(3):206-12.

Gruberg L, Pinnow E, Flood R, et al. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. Am J Cardiol. 2000;86(6):680-2.

Selcuk H, Dinc L, Selcuk MT, et al. The relation between differential leukocyte count, neutrophil to lymphocyte ratio and the presence and severity of coronary artery disease. Open Journal of Internal Medicine. 2012;2:163-9

Prasad A, Stone GW, Stuckey TD, et al. Relation between leucocyte count, myonecrosis, myocardial perfusion, and outcomes following primary angioplasty. Am J Cardiol. 2007;99(8):1067-71.

Chia S, Nagurney JT, Brown DF, et al. 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(3):333-7.

Rashidi F, Rashidi A, Golmohamadi A, et al. Does absolute neutrophilia predict early congestive heart failure after acute myocardial infarction? A cross-sectional study. Southern medical journal. 2008;101(1):19-23.

O'Donoghue M, Morrow DA, Cannon CP, et al. Association between baseline neutrophil count, clopidogrel therapy, and clinical and angiographic outcomes in patients with ST elevation myocardial infarction receiving fibrinolytic therapy. Eur Heart J. 2008;29(8):984-91.

Takahashi T, Hiasa Y, Ohara Y, et al. Relationship of admission neutrophil count to microvascular injury, left ventricular dilation, and long-term outcome in patients treated with primary angioplasty for acute myocardial infarction. Circ J. 2008;72(6):867-72.

Dogan I, Karaman K, Sonmez B, et al. Relationship between serum neutrophil count and infarct size in patients with acute myocardial infarction. Nucl Med Commun. 2009;30(10):797-801.

Balta S, Demirkol S, Unlu M, et al. Neutrophil to lymphocyte ratio may be predict of mortality in all conditions. Br J Cancer. 2013 Oct 1. doi: 10.1038/bjc.2013.598.

Mulvihill NT, Foley JB, Murphy RT, et al. Risk stratification in unstable angina and non-Q wave myocardial infarction using soluble cell adhesion molecules. Heart 2001; 85: 623-7

Downloads

Published

2014-05-02

Issue

Section

Articles

How to Cite

Preprocedural Neutrophil To Lymphocyte Ratio Predıcts Coronary Artery Perforation. (2014). Asian Journal of Pharmacy, Nursing and Medical Sciences, 2(2). https://ajouronline.com/index.php/AJPNMS/article/view/1231

Similar Articles

1-10 of 24

You may also start an advanced similarity search for this article.