Top

BMC Cardiovascular Disorders

Published in:

Open Access 01-12-2014 | Research article

The relation between neutrophil-to-lymphocyte ratio and coronary chronic total occlusions

Authors: Kenan Demir, Ahmet Avci, Bulent Behlul Altunkeser, Ahmet Yilmaz, Fikret Keles, Ahmet Ersecgin

Published in: BMC Cardiovascular Disorders | Issue 1/2014

Abstract

Background

Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that correlates with cardiac events. This study assessed the association between NLR and the presence of chronic coronary total occlusion (CTO).

Methods

The study population included 225 patients, a control group (n = 75), a coronary artery disease group (n = 75), and a CTO group (n = 75). NLR was compared in the three groups.

Results

NLR levels were significantly higher in the CTO than in the other two groups (p < 0.001). Bivariate correlation analysis showed a positive correlation between NLR and SYNTAX Score, and multivariate logistic regression analysis found that NLR was an independent predictor of CTO. ROC analysis showed that an NLR cut-off of 2.09 could distinguish between patients with and without CTO (AUC = 0.74; 95% CI, 0.68–0.81), with a specificity of 69.3% and a sensitivity of 61%.

Conclusion

NLR may be useful as a marker of CTO.

Available only for authorised users

Libby P: Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 2012, 32: 2045-2051. 10.1161/ATVBAHA.108.179705.CrossRefPubMedPubMedCentral

Brevetti G, Giugliano G, Brevetti L, Hiatt WR: Inflammation in peripheral artery disease. Circulation. 2010, 122: 1862-1875. 10.1161/CIRCULATIONAHA.109.918417.CrossRefPubMed

Brevetti G, Schiano V, Chiariello M: Endothelial dysfunction: a key to the pathophysiology and natural history of peripheral arterial disease?. Atherosclerosis. 2008, 197: 1-11. 10.1016/j.atherosclerosis.2007.11.002.CrossRefPubMed

Libby P: Inflammation in atherosclerosis. Nature. 2002, 420: 868-874. 10.1038/nature01323.CrossRefPubMed

Guasti L, Dentali F, Castiglioni L, Maroni L, Marino F, Squizzato A, Ageno W, Gianni M, Gaudio G, Grandi AM, Cosentino M, Venco A: 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: 591-599. 10.1160/TH11-02-0096.CrossRefPubMed

Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, Capodilupo R: Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol. 2011, 107: 433-438. 10.1016/j.amjcard.2010.09.039.CrossRefPubMed

Vatankulu MA, Sonmez O, Ertas G, Bacaksiz A, Turfan M, Erdogan E, Tasal A, Kul S, Uyarel H, Goktekin O: A new parameter predicting chronic total occlusion of coronary arteries: platelet distribution width. Angiology. 2014, 65: 60-64. 10.1177/0003319713486339.CrossRefPubMed

Yamane M: Current percutaneous recanalization of coronary chronic total occlusion. Rev Esp Cardiol. 2012, 65: 265-277. 10.1016/j.recesp.2011.10.026.CrossRefPubMed

Sönmez O, Ertaş G, Bacaksız A, Tasal A, Erdoğan E, Asoğlu E, Uyarel H, Göktekin O: Relation of neutrophil-to-lymphocyte ratio with the presence and complexity of coronary artery disease: an observational study. Anadolu Kardiyol Derg. 2013, 13: 662-667.PubMed

10.

Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I: Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989, 2: 358-367.CrossRefPubMed

11.

SYNTAX working-group: SYNTAX score calculator. 2012, http://www.syntaxscore.com,

12.

von Eckardstein A: Is there a need for novel cardiovascular risk factors?. Nephrol Dial Transplant. 2004, 19: 761-765. 10.1093/ndt/gfh111.CrossRefPubMed

13.

Lind L: Circulating markers of inflammation and atherosclerosis. Atherosclerosis. 2003, 169: 203-214. 10.1016/S0021-9150(03)00012-1.CrossRefPubMed

14.

Shen XH, Chen Q, Shi Y, Li HW: Association of neutrophil/lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Chin Med J. 2010, 123: 3438-3443.PubMed

15.

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: 27-31. 10.1016/j.cca.2008.04.019.CrossRefPubMed

16.

Gul M, Uyarel H, Ergelen M, Ugur M, Isık T, Ayhan E, Turkkan C, Aksu HU, Akgul O, Uslu N: Predictive value of neutrophil to lymphocyte ratio in clinical outcomes of non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up. Clin Appl Thromb Hemost. 2012, 20: 378-384.CrossRefPubMed

17.

Kaya MG, Akpek M, Lam YY, Yarlioglues M, Celik T, Gunebakmaz O, Duran M, Ulucan S, Keser A, Oguzhan A, Gibson MC: Prognostic value of neutrophil/ lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention: a prospective, multicenter study. Int J Cardiol. 2013, 168: 1154-1159. 10.1016/j.ijcard.2012.11.074.CrossRefPubMed

18.

Tasoglu I, Turak O, Nazli Y, Ozcan F, Colak N, Sahin S, Kavasoglu K, Genc B, Sert D, Karahan M, Cicek O, Ecevit A: Preoperative neutrophil lymphocyte ratio and saphenous vein graft patency after coronary artery bypass grafting. Clin Appl Thromb Hemost. 2013, 10: 1-6.

19.

Farooq V, Head SJ, Kappetein AP, Serruys PW: Widening clinical applications of the SYNTAX Score. Heart. 2013, 0: 1-12.

20.

Gensini GG: A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol. 1983, 51: 606-607. 10.1016/S0002-9149(83)80105-2.CrossRefPubMed

21.

Christofferson RD, Lehmann KG, Martin GV, Every N, Caldwell JH, Kapadia SR: Effect of chronic total coronary occlusion on treatment strategy. Am J Cardiol. 2005, 95: 1088-1091. 10.1016/j.amjcard.2004.12.065.CrossRefPubMed

22.

Drakopoulou M, Toutouzas K, Stefanadi E, Tsiamis E, Tousoulis D, Stefanadis C: Association of inflammatory markers with angiographic severity and extent of coronary artery disease. Atherosclerosis. 2009, 206: 335-339. 10.1016/j.atherosclerosis.2009.01.041.CrossRefPubMed

23.

Ateş AH, Canpolat U, Yorgun H, Kaya EB, Sunman H, Demiri E, Taher A, Hazirolan T, Aytemir K, Tokgözoglu L, Kabakçi G, Oto A: Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual source multislice computed tomographic coronary angiography. Cardiol J. 2011, 18: 371-377.PubMed

24.

Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, McCabe CH, Braunwald E, Gibson CM: 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: 1761-1768. 10.1016/S0735-1097(02)02484-1.CrossRefPubMed

25.

van Gaal WJ, Ponnuthurai FA, Selvanayagam J, Testa L, Porto I, Neubauer S, Banning AP: The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention. Int J Cardiol. 2009, 135: 60-65. 10.1016/j.ijcard.2008.03.033.CrossRefPubMed

26.

Kaya A, Kurt M, Tanboga IH, Isik T, Günaydin ZY, Kaya Y, Topcu S, Sevimli S: Relation of neutrophil to lymphocyte ratio with the presence and severity of stable coronary artery disease. Clin Appl Thromb Hemost. 2013, 0: 1-5.

27.

Jaffe R, Leung G, Munce NR, Thind AS, Leong-Poi H, Anderson KJ, Qi X, Trogadis J, Nadler A, Shiff D, Saperia J, Lockwood J, Jacobs C, Qiang B, Teitelbaum A, Dick AJ, Sparkes JD, Butany J, Wright GA, Strauss BH: Natural history of experimental arterial chronic total occlusions. J Am Coll Cardiol. 2009, 53: 1148-1158. 10.1016/j.jacc.2008.09.064.CrossRefPubMedPubMedCentral

28.

Finn AV, Kolodgie FD, Nakano M, Virmani R: The differences between neovascularization of chronic total occlusion and ıntraplaque angiogenesis. JACC Cardiovasc Imaging. 2010, 38: 806-810.CrossRef

29.

Srivatsa SS, Edwards WD, Boos CM, Grill DE, Sangiorgi GM, Garratt KN, Schwartz RS, Holmes DR: Histologic correlates of angiographic chronic total coronary artery occlusions. J Am Coll Cardiol. 1997, 29: 955-963. 10.1016/S0735-1097(97)00035-1.CrossRefPubMed

30.

Kalkan M, Sahin M, Kalkan A, Güler A, Tas M, Bulut M, Demir S, Acar R, Arslantas U, Oztürkeri B, Güler Y, Akçakoyun M: The relationship between the neutrophil-lymphocyte ratio and the coronary collateral circulation in patients with chronic total occlusion. Perfusion. 2014, doi:10.1177/0267659114521102

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/14/130/prepub

Title: The relation between neutrophil-to-lymphocyte ratio and coronary chronic total occlusions
Authors: Kenan Demir
Ahmet Avci
Bulent Behlul Altunkeser
Ahmet Yilmaz
Fikret Keles
Ahmet Ersecgin
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2014
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/1471-2261-14-130

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The relation between neutrophil-to-lymphocyte ratio and coronary chronic total occlusions

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2014

RETRACTED ARTICLE: Cardioprotective activity of placental growth factor in a rat model of acute myocardial infarction: nanoparticle-based delivery versus direct myocardial injection

Factors affecting diagnosis and management of hypertension in Mazowe District of Mashonaland Central Province in Zimbabwe: 2012

Rheumatic heart disease in Uganda: the association between MHC class II HLA DR alleles and disease: a case control study

Major adverse cardiovascular events in adult congenital heart disease: a population-based follow-up study from Taiwan

Population risk factor estimates for abdominal aortic aneurysm from electronic medical records: a case control study

Partial anomalous pulmonary venous connection to superior vena cava that overrides across the intact atrial septum and has bi-atrial connection in a 75-year-old female presenting with pulmonary hypertension

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page