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Pre-procedural neutrophil-to-lymphocyte ratio and long-term cardiac outcomes after percutaneous coronary intervention for stable coronary artery disease.
Atherosclerosis. 2017 Oct; 265:35-40.A

Abstract

BACKGROUND AND AIMS

An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with worse clinical outcomes in patients with acute coronary syndrome. However, the long-term prognostic value of NLR in stable coronary artery disease (CAD) after percutaneous coronary intervention (PCI) has not been fully investigated. The aim of this study was to determine whether NLR is an independent predictor of long-term cardiac outcomes after PCI.

METHODS

A total of 2070 patients with CAD who underwent elective PCI were enrolled in the study. Patients were divided into three groups by NLR tertile (<1.7, 1.7-2.5, and 2.5<). Incidences of all-cause death and cardiac death were evaluated.

RESULTS

During follow-up (median, 7.4 years), 300 patients (14.5%) died. Kaplan-Meier curves revealed ongoing divergence in rates of all-cause death and cardiac death among tertiles (both log-rank p < 0.01). In multivariate analysis, using the lowest tertile as reference, the highest tertile remained significantly associated with greater incidences of all-cause death (hazard ratio (HR), 1.73; 95% confidence interval (CI), 1.29-2.34; p = 0.0002). Continuous NLR values were also an independent predictor of all-cause death (HR, 1.87 per log NLR 1 increase; 95% CI, 1.50-2.32; p < 0.0001) and cardiac death (HR, 2.11; 95% CI, 1.46-3.05; p < 0.0001). Adding NLR values to a baseline model with established risk factors improved the C-index (p = 0.002), net reclassification improvement (p = 0.008) and integrated discrimination improvement (p = 0.0001) for all-cause death.

CONCLUSIONS

Elevated NLR was an independent predictor of long-term cardiovascular outcomes after elective PCI. Assessing pre-PCI NLR may be useful for risk stratification of stable CAD.

Authors+Show Affiliations

Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: tdohi@juntendo.ac.jp.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Cardiology, Suez Canal University, Ismailia, Egypt.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28843126

Citation

Wada, Hideki, et al. "Pre-procedural Neutrophil-to-lymphocyte Ratio and Long-term Cardiac Outcomes After Percutaneous Coronary Intervention for Stable Coronary Artery Disease." Atherosclerosis, vol. 265, 2017, pp. 35-40.
Wada H, Dohi T, Miyauchi K, et al. Pre-procedural neutrophil-to-lymphocyte ratio and long-term cardiac outcomes after percutaneous coronary intervention for stable coronary artery disease. Atherosclerosis. 2017;265:35-40.
Wada, H., Dohi, T., Miyauchi, K., Shitara, J., Endo, H., Doi, S., Konishi, H., Naito, R., Tsuboi, S., Ogita, M., Kasai, T., Hassan, A., Okazaki, S., Isoda, K., Suwa, S., & Daida, H. (2017). Pre-procedural neutrophil-to-lymphocyte ratio and long-term cardiac outcomes after percutaneous coronary intervention for stable coronary artery disease. Atherosclerosis, 265, 35-40. https://doi.org/10.1016/j.atherosclerosis.2017.08.007
Wada H, et al. Pre-procedural Neutrophil-to-lymphocyte Ratio and Long-term Cardiac Outcomes After Percutaneous Coronary Intervention for Stable Coronary Artery Disease. Atherosclerosis. 2017;265:35-40. PubMed PMID: 28843126.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pre-procedural neutrophil-to-lymphocyte ratio and long-term cardiac outcomes after percutaneous coronary intervention for stable coronary artery disease. AU - Wada,Hideki, AU - Dohi,Tomotaka, AU - Miyauchi,Katsumi, AU - Shitara,Jun, AU - Endo,Hirohisa, AU - Doi,Shinichiro, AU - Konishi,Hirokazu, AU - Naito,Ryo, AU - Tsuboi,Shuta, AU - Ogita,Manabu, AU - Kasai,Takatoshi, AU - Hassan,Ahmed, AU - Okazaki,Shinya, AU - Isoda,Kikuo, AU - Suwa,Satoru, AU - Daida,Hiroyuki, Y1 - 2017/08/18/ PY - 2017/06/01/received PY - 2017/07/12/revised PY - 2017/08/17/accepted PY - 2017/8/27/pubmed PY - 2018/6/5/medline PY - 2017/8/27/entrez KW - Atherosclerosis KW - Coronary artery disease KW - Inflammation SP - 35 EP - 40 JF - Atherosclerosis JO - Atherosclerosis VL - 265 N2 - BACKGROUND AND AIMS: An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with worse clinical outcomes in patients with acute coronary syndrome. However, the long-term prognostic value of NLR in stable coronary artery disease (CAD) after percutaneous coronary intervention (PCI) has not been fully investigated. The aim of this study was to determine whether NLR is an independent predictor of long-term cardiac outcomes after PCI. METHODS: A total of 2070 patients with CAD who underwent elective PCI were enrolled in the study. Patients were divided into three groups by NLR tertile (<1.7, 1.7-2.5, and 2.5<). Incidences of all-cause death and cardiac death were evaluated. RESULTS: During follow-up (median, 7.4 years), 300 patients (14.5%) died. Kaplan-Meier curves revealed ongoing divergence in rates of all-cause death and cardiac death among tertiles (both log-rank p < 0.01). In multivariate analysis, using the lowest tertile as reference, the highest tertile remained significantly associated with greater incidences of all-cause death (hazard ratio (HR), 1.73; 95% confidence interval (CI), 1.29-2.34; p = 0.0002). Continuous NLR values were also an independent predictor of all-cause death (HR, 1.87 per log NLR 1 increase; 95% CI, 1.50-2.32; p < 0.0001) and cardiac death (HR, 2.11; 95% CI, 1.46-3.05; p < 0.0001). Adding NLR values to a baseline model with established risk factors improved the C-index (p = 0.002), net reclassification improvement (p = 0.008) and integrated discrimination improvement (p = 0.0001) for all-cause death. CONCLUSIONS: Elevated NLR was an independent predictor of long-term cardiovascular outcomes after elective PCI. Assessing pre-PCI NLR may be useful for risk stratification of stable CAD. SN - 1879-1484 UR - https://www.unboundmedicine.com/medline/citation/28843126/Pre_procedural_neutrophil_to_lymphocyte_ratio_and_long_term_cardiac_outcomes_after_percutaneous_coronary_intervention_for_stable_coronary_artery_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0021-9150(17)31229-7 DB - PRIME DP - Unbound Medicine ER -