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Journal of Cardiothoracic Surgery

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Open Access 01-12-2013 | Research article

Elevated preoperative neutrophil/lymphocyte ratio as a predictor of increased long-term survival in minimal invasive coronary artery bypass surgery compared to sternotomy

Authors: Basem Azab, Masood A Shariff, Rana Bachir, John P Nabagiez, Joseph T McGinn Jr

Published in: Journal of Cardiothoracic Surgery | Issue 1/2013

Abstract

Background

Neutrophil lymphocyte ratio (NLR) is a predictor of major adverse cardiovascular outcomes. Our study explores the value of NLR in predicting long-term mortality after minimally invasive coronary artery bypass surgery (MICS) via lateral left-thoracotomy versus conventional sternotomy coronary artery bypass grafting (CABG) surgery.

Methods

A total of 1126 consecutive patients (729 sternotomy CABG and 397 MICS) from a single tertiary center between 2005 and 2008 were followed until 2011. We stratified the patients into equal tertiles according to preoperative NLR. The primary outcome, all-cause mortality, was compared among the NLR tertiles.

Results

Out of the 1126 patients included in the study, 1030 (91%) patients underwent off-pump CABG . The first (NLR <2.3) tertile had a significantly lower 5-year mortality (30/371 =8%) in comparison to the second (NLR =2.3-3.4) and third (NLR ≥3.5) tertiles (49/375 =13% and 75/380 =20%), respectively with p < 0.0001. After multivariate adjustment, NLR was a significant independent predictor of mortality (hazard ratio [HR] per each unit increase of NLR was 1.05, 95% confidence interval [CI] 1.01-1.10, p = 0.008). MICS and sternotomy CABG groups with NLR <3 had similar mortality (21/221 =9.5% and 40/403 =9.9%), p = 1. However among patients with NLR ≥3, MICS had a significantly lower mortality (23/176 = 13.1%) compared to the sternotomy CABG (70/326 =21.5%), p = 0.02. According to the multivariate analysis of patients with NLR ≥3, MICS had a significantly lower mortality compared to sternotomy CABG (HR = 0.44, 95% CI 0.24-0.78, p = 0.005).

Conclusion

Elevated preoperative NLR is an independent predictor of long-term mortality after CABG. Among the patients with NLR ≥ 3, MICS was associated with a significantly improved survival compared with sternotomy CABG.

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Núñez J, Núñez E, Bodí V, Sanchis J, Miñana G, Mainar L, Santas E, Merlos P, Rumiz E, Darmofal H, Heatta AM, Llàcer A: Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation MI. Am J Cardiol. 2008, 101: 747-752. 10.1016/j.amjcard.2007.11.004.CrossRefPubMed

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 CAD. Clin Chim Acta. 2008, 395: 27-31. 10.1016/j.cca.2008.04.019.CrossRefPubMed

Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, Gobunsuy R, Jadonath S, Baldari D, McCord D, Lafferty J: Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation MI. Am J Cardiol. 2010, 106 (4): 470-476. 10.1016/j.amjcard.2010.03.062.CrossRefPubMed

Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G, Jeffrey RR, Buchan KG, El-Shafei H, Hillis GS: Preoperative NLR and outcome from CABG. Am Heart J. 2007, 154: 995-1002. 10.1016/j.ahj.2007.06.043.CrossRefPubMed

McGinn JT, Usman S, Lapierre H, Pothula VR, Mesana TG, Ruel M: Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients. Circulation. 2009, 120 (11 Suppl): S78-S84.CrossRefPubMed

Dandona P, Aljada A, Bandyopadhyay A: Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol. 2004, 25 (1): 4-7. 10.1016/j.it.2003.10.013.CrossRefPubMed

Miyamoto T, Carrero JJ, Stenvinkel P: Inflammation as a risk factor and target for therapy in CKD. Curr Opin Nephrol Hypertens. 2011, 20 (6): 662-668. 10.1097/MNH.0b013e32834ad504.CrossRefPubMed

Hemdahl AL, Gabrielsen A, Zhu C, Eriksson P, Hedin U, Kastrup J, Thorén P, Hansson GK: Expression of neutrophil gelatinase- associated lipocalin in atherosclerosis and MI. Arterioscler, Thromb, Vasc Biol. 2006, 26 (1): 136-142. 10.1161/01.ATV.0000193567.88685.f4.CrossRef

Henriksen PA, Sallenave JM: Human neutrophil elastase: mediator and therapeutic target in atherosclerosis. Int J Biochem Cell Biol. 2008, 40 (6–7): 1095-1100.CrossRefPubMed

10.

Roman RM, Camargo PV, Borges FK, Rossini AP, Polanczyk CA: Prognostic value of myeloperoxidase in coronary artery disease: comparison of unstable and stable angina patients. Coron Artery Dis. 2010, 21 (3): 129-136. 10.1097/MCA.0b013e328333f50d.CrossRefPubMed

11.

Döring Y, Drechsler M, Wantha S, Kemmerich K, Lievens D, Vijayan S, Gallo RL, Weber C, Soehnlein O: Lack of neutrophil-Derived CRAMP reduces atherosclerosis in mice. Circ Res. 2012, 110 (8): 1052-1056. 10.1161/CIRCRESAHA.112.265868.CrossRefPubMed

12.

Chello M, Anselmi A, Spadaccio C, Patti G, Goffredo C, Di Sciascio G, Covino E: Simvastatin increases neutrophil apoptosis and reduces inflammatory reaction after coronary surgery. Ann Thorac Surg. 2007, 83 (4): 1374-1380. 10.1016/j.athoracsur.2006.10.065.CrossRefPubMed

13.

Chello M, Mastroroberto P, Patti G, D’Ambrosio A, Morichetti MC, Di Sciascio G, Covino E: Simvastatin attenuates leucocyte-endothelial interactions after coronary revascularisation with CPB. Heart. 2003, 89 (5): 538-543. 10.1136/heart.89.5.538.CrossRefPubMedPubMedCentral

14.

Major AS, Fazio S, Linton MF: B-lymphocyte deficiency increases atherosclerosis in LDL receptor-null mice. Arterioscler, Thromb, Vasc Biol. 2002, 22 (11): 1892-1898. 10.1161/01.ATV.0000039169.47943.EE.CrossRef

15.

Núñez J, Sanchis J, Bodí V, Núñez E, Mainar L, Heatta AM, Husser O, Miñana G, Merlos P, Darmofal H, Pellicer M, Llàcer A: Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. Atherosclerosis. 2009, 206 (1): 251-257. 10.1016/j.atherosclerosis.2009.01.029.CrossRefPubMed

16.

Hansson GK, Holm J, Holm S, Fotev Z, Hedrich HJ, Fingerle J: T-lymphocytes inhibit the vascular response to injury. Proc Natl Acad Sci USA. 1991, 88: 10530-10534. 10.1073/pnas.88.23.10530.CrossRefPubMedPubMedCentral

17.

Gu YJ, Mariani MA, van Oeveren W, Grandjean JG, Boonstra PW: Reduction of the inflammatory response in patients undergoing minimally invasive CABG. Ann Thorac Surg. 1998, 65 (2): 420-424. 10.1016/S0003-4975(97)01127-2.CrossRefPubMed

18.

Gu YJ, Mariani MA, Boonstra PW, Grandjean JG, van Oeveren W: Complement activation in coronary artery bypass grafting patients without cardiopulmonary bypass: the role of tissue injury by surgical incision. Chest. 1999, 116 (4): 892-898. 10.1378/chest.116.4.892.CrossRefPubMed

19.

Diegeler A, Doll N, Rauch T, Haberer D, Walther T, Falk V, Gummert J, Autschbach R, Mohr FW: Humoral immune response during CABG: A comparison of limited approach, “off-pump” technique, and conventional CPB. Circulation. 2000, 102 (19 Suppl 3): III95-III100.PubMed

20.

Friscia ME, Zhu J, Kolff JW, Chen Z, Kaiser LR, Deutschman CS, Shrager JB: Cytokine response is lower after lung volume reduction through bilateral thoracoscopy versus sternotomy. Ann Thorac Surg. 2007, 83 (1): 252-256. 10.1016/j.athoracsur.2006.08.012.CrossRefPubMed

21.

Hayashi Y, Sawa Y, Nishimura M, Satoh H, Ohtake S, Matsuda H: Avoidance of full sternotomy: effect on inflammatory cytokine production during CPB in rats. J Card Surg. 2003, 18 (5): 390-395. 10.1046/j.1540-8191.2003.02046.x.CrossRefPubMed

22.

MacDonald K, Mackenzie S: What happens to the thymus in children who have undergone a median sternotomy?. Pediatr Radiol. 2009, 39 (6): 616-621. 10.1007/s00247-009-1202-0.CrossRefPubMed

23.

Halnon NJ, Cooper P, Chen DY, Boechat MI, Uittenbogaart CH: Immune dysregulation after cardiothoracic surgery and incidental thymectomy: maintenance of regulatory T cells despite impaired thymopoiesis. Clin Dev Immunol. 2011, 2011: 915864-CrossRefPubMedPubMedCentral

24.

Mevorach D, Perrot S, Buchanan NM, Khamashta M, Laoussadi S, Hughes GR, Menkes CJ: Appearance of systemic lupus erythematosus after thymectomy: four case reports and review of the literature. Lupus. 1995, 4 (1): 33-37. 10.1177/096120339500400108.CrossRefPubMed

25.

Gerli R, Paganelli R, Cossarizza A, Muscat C, Piccolo G, Barbieri D, Mariotti S, Monti D, Bistoni O, Raiola E, Venanzi FM, Bertotto A, Franceschi C: Long-term immunologic effects of thymectomy in patients with myasthenia gravis. J Allergy Clin Immunol. 1999, 103 (5 Pt 1): 865-872.CrossRefPubMed

Title: Elevated preoperative neutrophil/lymphocyte ratio as a predictor of increased long-term survival in minimal invasive coronary artery bypass surgery compared to sternotomy
Authors: Basem Azab
Masood A Shariff
Rana Bachir
John P Nabagiez
Joseph T McGinn Jr
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2013
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/1749-8090-8-193

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Elevated preoperative neutrophil/lymphocyte ratio as a predictor of increased long-term survival in minimal invasive coronary artery bypass surgery compared to sternotomy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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