Changes in the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios before and after percutaneous coronary intervention and their impact on the prognosis of patients with acute coronary syndrome

Sheng, Jianlong; Liu, Nina; He, Fei; Cheng, Cheng; Shen, Shichun; Sun, Yuting

doi:10.6061/clinics/2021/e2580

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ORIGINAL ARTICLE • Clinics 76 • 2021 • https://doi.org/10.6061/clinics/2021/e2580 copy

Changes in the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios before and after percutaneous coronary intervention and their impact on the prognosis of patients with acute coronary syndrome

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

This study aimed to prospectively observe the changes in the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) before and after percutaneous coronary intervention (PCI) and their impact on the prognosis of patients with acute coronary syndrome (ACS).

METHODS:

Blood samples from 205 patients with ACS were collected at admission and at 24h and 30 days post-PCI to observe changes in the complete blood count. The Cox multivariate regression model was used to analyze the factors influencing major adverse cardiac events (MACE) after PCI in patients with ACS. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value of inflammation indicators for MACE after PCI.

RESULTS:

Following PCI, NLR and PLR first increased postoperatively and then decreased within 30 days after PCI. Cox multivariate regression analysis showed that NLR and PLR at 24h post-PCI and acute ST-segment elevation myocardial infarction were independent influencing factors for the incidence of MACE after PCI. The ROC curve analysis showed that the NLR at 24h post-PCI was a better predictor of the incidence of MACE. The NLR at 24h post-PCI was significantly correlated with the number and length of implanted stents and operation duration.

CONCLUSIONS:

After PCI, patients with ACS had an increased neutrophil proportion and NLR. The NLR at 24h post-PCI was a better predictor of the incidence of postoperative MACE.

Neutrophil-to-Lymphocyte Ratio; Platelet-to-Lymphocyte Ratio; Percutaneous Coronary Intervention; Acute Coronary Syndrome

	UA	non-STEMI	STEMI	p-value
Number of patients	156	25	24
Sex (M/F)	108/48	18/7	12/12	0.151
Age (years)	63.6±10.6	66.5±10.8	71.1±9.8*	0.004
Hypertension, n (%)	113 (72.4)	16 (64.0)	13 (54.2)	0.163
Heart failure, n (%)	8 (5.1)	1 (4.0)	2 (8.3)	0.769
Cerebrovascular disease, n (%)	26 (16.7)	3 (12.0)	5 (20.8)	0.707
Diabetes, n (%)	51 (32.7)	9 (36.0)	3 (12.5)	0.113
CKD, n (%)	8 (5.1)	1 (4.0)	2 (8.3)	0.769
Smoking, n (%)	31 (19.9)	3 (12.0)	3 (12.5)	0.480
Drinking, n (%)	18 (11.5)	2 (8.0)	1 (4.2)	0.816
Type of P2Y12 antagonist				0.120
Ticagrelor	99 (63.5)	12 (48.0)	11(45.8)
Clopidogrel	57 (36.5)	13 (52.0)	13 (54.2)
β-blocker treatment	125 (80.1)	20 (80.0)	20 (83.3)	0.756
ACEI/ARB treatment	112 (71.2)	19 (76.0)	18 (75.0)	0.876
Statin treatment	149 (95.5)	24 (96.0)	23 (95.8)	0.992
PPI treatment	120 (76.9)	22 (88.0)	20 (83.3)	0.635
SYNTAX score	14.3±7.6	17.0±7.1	17.1±7.7	0.071
Number of treated coronary artery (Median)	1 (1-1)	1 (1-1)	1 (1-2)	0.222
Number of stents	1 (1-2)	2 (1-2)	2 (1-2)	0.071
Total length of stents (mm)	36.0 (24.0-57.8)	52.0 (33.0-65.5)	46.0 (33.0-66.8)	0.296
Maximum pressure of balloon dilation (MPa)	1.8 (1.6-2.0)	1.8 (1.6-2.0)	2.0 (1.8-2.0)	0.770
Operation duration (min)	50.0 (36.0-66.0)	55.0 (42.5-65.5)	49.0 (40.0-60.0)	0.792

	WBC, k/μL	Platelet, k/μL	Neutrophil, k/μL	Lymphocyte, k/μL
ACS (n=205)
Pre-PCI	7.15±2.19	199.64±58.09	4.66±1.98	1.82±0.67
24h post-PCI	7.20±1.90	188.77±55.88^* * p<0.05, compared with Pre-PCI.	5.06±1.61^* * p<0.05, compared with Pre-PCI.	1.52±0.57^* * p<0.05, compared with Pre-PCI.
30 days post-PCI	6.60±1.42^* * p<0.05, compared with Pre-PCI. ^⋇ ⋇ p<0.05, compared with 24h post-PCI.	191.15±55.30^* * p<0.05, compared with Pre-PCI.	4.28±1.13^⋇ ⋇ p<0.05, compared with 24h post-PCI.	1.72±0.58^* * p<0.05, compared with Pre-PCI. ^⋇ ⋇ p<0.05, compared with 24h post-PCI.
UA (n=156)
Pre-PCI	6.77±1.84	198.63±56.58	4.27±1.55	1.85±0.70
24h post-PCI	7.07±1.72^* * p<0.05, compared with Pre-PCI.	187.25±54.32^* * p<0.05, compared with Pre-PCI.	4.92±1.43^* * p<0.05, compared with Pre-PCI.	1.53±0.57^* * p<0.05, compared with Pre-PCI.
30 days post-PCI	6.50±1.43^⋇ ⋇ p<0.05, compared with 24h post-PCI.	190.23±54.80^* * p<0.05, compared with Pre-PCI.	4.19±1.11^⋇ ⋇ p<0.05, compared with 24h post-PCI.	1.71±0.58^* * p<0.05, compared with Pre-PCI. ^⋇ ⋇ p<0.05, compared with 24h post-PCI.
non-STEMI (n=25)
Pre-PCI	7.60±1.55	188.08±48.85	5.19±1.39^Δ Δ p<0.05, compared with UA.	1.68±0.61
24h post-PCI	7.55±1.96	185.56±48.19	5.32±1.56	1.58±0.67
30 days post-PCI	7.07±1.45	185.88±56.56	4.67±1.21^⋇ ⋇ p<0.05, compared with 24h post-PCI.	1.82±0.68^⋇ ⋇ p<0.05, compared with 24h post-PCI.
STEMI (n=24)
Pre-PCI	9.12±3.46^Δ Δ p<0.05, compared with UA.	218.21±73.18	6.61±3.32^Δ Δ p<0.05, compared with UA.	1.78±0.58
24h post-PCI	7.70±2.77^* * p<0.05, compared with Pre-PCI.	201.96±72.01	5.65±2.51	1.38±0.42^* * p<0.05, compared with Pre-PCI.
30 days post-PCI	6.81±1.27^* * p<0.05, compared with Pre-PCI. ^⋇ ⋇ p<0.05, compared with 24h post-PCI.	202.63±58.11	4.47±1.13^* * p<0.05, compared with Pre-PCI. ^⋇ ⋇ p<0.05, compared with 24h post-PCI.	1.66±0.52^⋇ ⋇ p<0.05, compared with 24h post-PCI.

	Neutrophil, percentage	Lymphocyte, percentage	NLR	PLR
ACS (n=205)
Pre-PCI	63.74±10.43	26.50±9.02	2.95±1.83	121.52±51.72
24h post-PCI	69.65±7.69^* * p<0.05, compared with Pre-PCI.	21.56±7.03^* * p<0.05, compared with Pre-PCI.	3.75±1.88^* * p<0.05, compared with Pre-PCI.	137.48±57.61^* * p<0.05, compared with Pre-PCI.
30 days post-PCI	64.56±8.08^⋇ ⋇ p<0.05, compared with 24h post-PCI.	26.22±7.21^⋇ ⋇ p<0.05, compared with 24h post-PCI.	2.77±1.20^⋇ ⋇ p<0.05, compared with 24h post-PCI.	122.54±52.55^⋇ ⋇ p<0.05, compared with 24h post-PCI.
UA (n=156)
Pre-PCI	62.21±9.94	27.92±8.88	2.68±1.68	120.04±52.84
24h post-PCI	69.21±7.77^* * p<0.05, compared with Pre-PCI.	21.99±7.24^* * p<0.05, compared with Pre-PCI.	3.63±1.68^* * p<0.05, compared with Pre-PCI.	135.82±58.22^* * p<0.05, compared with Pre-PCI.
30 days post-PCI	64.24±8.16^* * p<0.05, compared with Pre-PCI. ^⋇ ⋇ p<0.05, compared with 24h post-PCI.	26.51±7.16^* * p<0.05, compared with Pre-PCI. ^⋇ ⋇ p<0.05, compared with 24h post-PCI.	2.72±1.18^⋇ ⋇ p<0.05, compared with 24h post-PCI.	122.68±54.38^⋇ ⋇ p<0.05, compared with 24h post-PCI.
non-STEMI (n=25)
Pre-PCI	67.54±9.54	22.55±7.35	3.58±1.87	123.29±48.92
24h post-PCI	70.31±7.75	21.21±6.96	3.85±1.75	133.10±51.72
30 days post-PCI	65.74±7.78^⋇ ⋇ p<0.05, compared with 24h post-PCI.	26.42±8.58^* * p<0.05, compared with Pre-PCI. ^⋇ ⋇ p<0.05, compared with 24h post-PCI.	2.94±1.45^* * p<0.05, compared with Pre-PCI. ^⋇ ⋇ p<0.05, compared with 24h post-PCI.	114.64±47.66^⋇ ⋇ p<0.05, compared with 24h post-PCI.
STEMI (n=24)
Pre-PCI	69.69±11.65^Δ Δ p<0.05, compared with UA.	21.42±8.70^Δ Δ p<0.05, compared with UA.	4.02±2.24^Δ Δ p<0.05, compared with UA.	129.33±48.20
24h post-PCI	71.78±6.96	19.08±5.21	4.40±2.97	152.83±59.35
30 days post-PCI	65.42±8.02^⋇ ⋇ p<0.05, compared with 24h post-PCI.	24.14±5.81^⋇ ⋇ p<0.05, compared with 24h post-PCI.	2.91±1.06^⋇ ⋇ p<0.05, compared with 24h post-PCI.	129.86±45.48

	B	Wald	p-value	HR	95% CI
	B	Wald	p-value	HR	Lower bound	Upper bound
Sex	0.82	0.65	0.419	2.27	0.31	16.64
Age	−0.07	1.31	0.253	0.93	0.82	1.05
Hypertension	2.30	2.83	0.093	10.00	0.68	146.42
Heart failure	0.08	0.00	0.959	1.08	0.05	21.23
Cerebrovascular disease	1.56	2.69	0.101	4.76	0.74	30.63
Diabetes	0.24	0.06	0.808	1.28	0.18	9.03
CKD	−2.79	2.42	0.120	0.06	0.00	2.07
Smoking	−0.34	0.04	0.840	0.71	0.03	18.53
Type of P2Y12 antagonist	−2.18	1.39	0.239	0.11	0.00	4.25
acute STEMI	1.54	4.26	0.039	4.65	1.08	20.02
SYNTAX score	0.07	1.55	0.213	1.07	0.96	1.20
NLR pre-PCI	−0.13	0.14	0.712	0.88	0.45	1.72
PLR pre-PCI	0.02	1.47	0.225	1.02	0.99	1.05
NLR 24h post-PCI	1.35	7.81	0.005	3.84	1.50	9.89
PLR 24h post-PCI	0.04	4.48	0.034	1.05	1.01	1.10
NLR 30 days post-PCI	0.68	2.14	0.143	1.97	0.80	4.86
PLR 30 days post-PCI	0.02	1.50	0.221	1.02	0.99	1.05

	Area under the curve	Standard error	p-value	95% CI of Area
	Area under the curve	Standard error	p-value	Lower bound	Upper bound
NLR	0.862	0.042	<0.001	0.779	0.945
PLR	0.703	0.061	0.004	0.583	0.822

	r	p-value
Age	0.127	0.069
SYNTAX score	0.055	0.434
Number of interventional coronary arteries	0.055	0.430
Number of stents	0.140	0.046
Total length of stents (mm)	0.172	0.014
Maximum pressure of balloon dilation (kPa)	0.071	0.308
Operation duration (min)	0.199	0.004
PLR 24h post-PCI	0.616	<0.001
IL-6 24h post-PCI	0.286	<0.001
hsCRP 24h post-PCI	0.248	<0.001

	r	p-value
Age	0.122	0.082
SYNTAX score	0.056	0.422
Number of treated coronary arteries	−0.007	0.919
Number of stents	0.020	0.772
Total length of stents (mm)	0.042	0.546
Maximum pressure of balloon dilation (kPa)	0.060	0.393
Operation duration (min)	0.106	0.132
NLR 24h post-PCI	0.616	<0.001
IL-6 24h post-PCI	0.183	0.009
hsCRP 24h post-PCI	0.234	0.001

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[1] *Corresponding author. E-mail: shengjianlong1982@163.com