USEFULNESS OF NEUTROPHILS TO LYMPHOCYTES RATIO FOR PREDICTING TROPONIN-I ELEVATION IN PATIENTS PRESENTING WITH SUSPECTED NSTE-ACUTE CORONARY SYNDROME
Abstract
Background: Most of the admissions to the coronary care unit are patients who are having Non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Inflammation has an important role in the pathogenesis of the acute coronary syndrome. Inflammatory marker such as Leukocyte counts & most importantly Neutrophils to Lymphocyte Ratio (NLR) has been found an important predictor of cardiovascular events. Few studies show the diagnostic role of Neutrophils to Lymphocyte ratio in the patient presenting with NSTE-ACS. The objective of this study was to determine the diagnostic role of Neutrophils to Lymphocytes ratio to predict the elevation of Troponin-I in patients presenting with suspected NSTE-acute coronary syndrome. Methods: This was a Descriptive Case Series study, conducted in Cardiology department Ayub Teaching Hospital/Ayub Medical College Abbottabad, from 15th May 2017 to30th December 2018. A total of 203 patients with suspected NSTE-ACS were inducted in the study by non-probability, consecutive sampling. Results: Results of this study shown a strong correlation between Neutrophils to Lymphocyte ratio (NLR) & rise in Troponin-I levels. Furthermore, results shown that at 4th quartile of Neutrophils to Lymphocyte ratio (NLR) there is high Specificity (97.8%) and very high positive predictive of value 96.7% for predicting the rise in Troponin-I levels. Conclusion: We concluded that there is a strong correlation between rising Neutrophils to Lymphocyte ratio (NLR) and cardiac Troponin-I elevation in patients presenting with suspected NSTE-acute coronary syndrome. Therefore, this parameter can be used to predict the rise in troponin level in patients presenting with suspected NSTE-ACS.Keywords: Non-ST segment elevation myocardial infarction (NSTEMI); ST-segment depression; Neutrophils to Lymphocytes ratio; Non-ST elevation acute coronary syndrome; ElectrocardiogramReferences
Gaziano TA, Gaziano JM. Epidemiology of Cardiovascular Disease. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harrison Principals of Internal Medicine. 17th ed. Mc-Graw Hills, 2008; p.1377–78.
Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. AHA statistical update. Heart disease and stroke statistics–2012 Update. A report from the American Heart Association. Circulation 2012;125(1):e2–20.
Abbas S, Kitchlew AR, Abbas S. Disease burden of Ischemic Heart Disease in Pakistan and its risk factors. Ann Pak Inst Med Sci 2009;5(3):145–50.
Daga LC, Kaul U, Mansoor A. Approach to STEMI and NSTEMI. J Assoc Physicians India 2011;59(Suppl 12):19–25.
Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part I. Mayo Clin Proc 2009;84(10):917–38.
Giugliano RP, Braunwald E. The Year in Non-ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2011;58(22):2342–54.
Lefebvre CW, Hoekstra J. Approach to non-ST-segment elevation acute coronary syndrome in the emergency department: risk stratification and treatment strategies. Hosp Pract (1995). 2010;38(2):40–9.
Cannon C, Braunwald E. Unstable Angina & Non-ST Elevation Myocardial Infarction. Braunwald's Heart Disease A Textbook of Cardiovascular Medicine. 9th ed. Elsevier: (Saunders), 2012; p.1179.
Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999;340(2):115–26.
Karabinos I, Koulouris S, Kranidis A, Pastromas S, Exadaktylos N, Kalofoutis A. Neutrophil Count on Admission Predicts Major In‐hospital Events in Patients with a Non‐ST‐Segment Elevation Acute Coronary Syndrome. Clin Cardiol 2009;32(10):561–8.
Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, et al. Relationship between baseline white blood cell count & degree of coronary artery disease & mortality in patients with acute coronary syndromes: A TACTICS-TIMI 18 (Treat Angina with Aggrastat ans determine cost of therapy with an invasive or conservative strategy-thrombolysis in myocardial infarction 18 trial) substudy. J Am Coll Cardiol 2000;40(10):1761–8.
Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short-and long-term mortality after non–ST-elevation myocardial infarction. Am J Cardiol 2010;106(4):470–6.
Yilmaz M, Tenekecioglu E, Arslan B, Bekler A, Ozluk OA, Karaagac K, et al. White Blood Cell Subtypes and Neutrophil–Lymphocyte Ratio in Prediction of Coronary Thrombus Formation in Non-ST-Segment Elevated Acute Coronary Syndrome. Clin Appl Thromb Hemost 2015;21(5):446–52.
Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 2012;225(2):456–60.
Altun B, Turkon H, Tasolar H, Beggı H, Altun M, Temız A, et al. The relationship between high-sensitive troponin T, neutrophil lymphocyte ratio and SYNTAX Score. Scand J Clin Lab Invest 2014;74(2):108–15.
Turak O, Ozcan F, Isleyen A, Tok D, Sokmen E, Buyukkaya E, et al. Usefulness of the neutrophil-to-lymphocyte ratio to predict bare-metal stent restenosis. Am J Cardiol 2012;110(10):1405–10.
Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011;107(3):433–8.
Roy D, Quiles J, Avanzas P, Arroyo-Espliguero R, Sinha M, Kaski JC. A comparative study of markers of inflammation for the assessment of cardiovascular risk in patients presenting to the emergency department with acute chest pain suggestive of acute coronary syndrome. Int J Cardiol 2006;109(3):317–21.
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(1-2):27–31.
Zazula AD, Precoma-Neto D, Gomes AM, Kruklis H, Barbieri GF, Forte RY, et al. An assessment of neutrophils / lymphocytes ratio in suspected patients of acute coronary syndrome. Arq Bras Cardiol 2008;90(1):31–6.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.