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Published in: BMC Cardiovascular Disorders 1/2020

Open Access 01-12-2020 | Non-ST-Segment Elevation Myocardial Infarction | Research article

The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: a systematic review and meta-analysis

Authors: Xiao-Qing Quan, Run-Chang Wang, Qing Zhang, Cun-Tai Zhang, Lei Sun

Published in: BMC Cardiovascular Disorders | Issue 1/2020

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Abstract

Background

The association between the lymphocyte-to-monocyte ratio (LMR) and prognosis in the patients with acute coronary syndrome (ACS) is not fully understood. We performed this systematic review and meta-analysis to evaluate the correlation between LMR and mortality or major adverse cardiac events (MACE) in patients with ACS.

Methods

A systematic search was performed in PubMed, MEDLINE, EMBASE, the Cochrane Library, Scopus, and Web of science. The association between LMR and mortality/MACE was analyzed in patients with ACS. The search was updated to April 15, 2020.

Results

A total of 5 studies comprising 4343 patients were included in this meta-analysis. The results showed that lower LMR predicted higher short-term mortality/MACE (hazard ratio [HR] = 3.44, 95% confidence interval [CI]: 1.46–8.14, P <  0.05) and long-term mortality/MACE (HR = 1.70, 95% CI: 1.36–2.13, P <  0.05). In the subgroup analysis, there was still statistical significance of long-term mortality/MACE in all subgroups.

Conclusions

This study suggested that lower LMR value might be associated with higher short-term and long-term mortality/MACE in ACS patients. Especially for younger ACS patients, low LMR was more closely associated with poor prognosis.
Literature
1.
go back to reference Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low- and middle-income countries. Curr Probl Cardiol. 2010;35:72–115.CrossRef Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low- and middle-income countries. Curr Probl Cardiol. 2010;35:72–115.CrossRef
2.
go back to reference Wang F, Zhang LY, Zhang P, Cheng Y, Ye BZ, He MA, et al. Effect of physical activity on hospital service use and expenditures of patients with coronary heart disease: results from Dongfeng-Tongji cohort study in China. Curr Med Sci. 2019;39:483–92.CrossRef Wang F, Zhang LY, Zhang P, Cheng Y, Ye BZ, He MA, et al. Effect of physical activity on hospital service use and expenditures of patients with coronary heart disease: results from Dongfeng-Tongji cohort study in China. Curr Med Sci. 2019;39:483–92.CrossRef
3.
go back to reference Makki N, Brennan TM, Girotra S. Acute coronary syndrome. J Intensive Care Med. 2015;30:186–200.CrossRef Makki N, Brennan TM, Girotra S. Acute coronary syndrome. J Intensive Care Med. 2015;30:186–200.CrossRef
4.
go back to reference Li SJ, Barywani S, Fu M. Relationship between physical inactivity and long-term outcome in patients aged >= 80 years with acute coronary syndrome. Curr Med Sci. 2018;38:64–9.CrossRef Li SJ, Barywani S, Fu M. Relationship between physical inactivity and long-term outcome in patients aged >= 80 years with acute coronary syndrome. Curr Med Sci. 2018;38:64–9.CrossRef
5.
go back to reference Dalen JE, Alpert JS, Goldberg RJ, Weinstein RS. The epidemic of the 20(th) century. Coronary heart disease. Am J Med. 2014;127:807–12.CrossRef Dalen JE, Alpert JS, Goldberg RJ, Weinstein RS. The epidemic of the 20(th) century. Coronary heart disease. Am J Med. 2014;127:807–12.CrossRef
6.
go back to reference Ding S, Lin N, Sheng X, Zhao Y, Su Y, Xu L, et al. Melatonin stabilizes rupture-prone vulnerable plaques via regulating macrophage polarization in a nuclear circadian receptor RORalpha-dependent manner. J Pineal Res. 2019;67:e12581.CrossRef Ding S, Lin N, Sheng X, Zhao Y, Su Y, Xu L, et al. Melatonin stabilizes rupture-prone vulnerable plaques via regulating macrophage polarization in a nuclear circadian receptor RORalpha-dependent manner. J Pineal Res. 2019;67:e12581.CrossRef
7.
go back to reference Wang Y, Sun X, Xia B, Le C, Li Z, Wang J, et al. The role of OX40L and ICAM-1 in the stability of coronary atherosclerotic plaques and their relationship with sudden coronary death. BMC Cardiovasc Disord. 2019;19:272.CrossRef Wang Y, Sun X, Xia B, Le C, Li Z, Wang J, et al. The role of OX40L and ICAM-1 in the stability of coronary atherosclerotic plaques and their relationship with sudden coronary death. BMC Cardiovasc Disord. 2019;19:272.CrossRef
8.
go back to reference Libby P. Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 2012;32:2045–51.CrossRef Libby P. Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 2012;32:2045–51.CrossRef
9.
go back to reference Libby P, Ridker PM, Hansson GK. Leducq transatlantic network on a. inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54:2129–38.CrossRef Libby P, Ridker PM, Hansson GK. Leducq transatlantic network on a. inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54:2129–38.CrossRef
10.
go back to reference Pant S, Deshmukh A, Gurumurthy GS, Pothineni NV, Watts TE, Romeo F, et al. Inflammation and atherosclerosis--revisited. J Cardiovasc Pharmacol Ther. 2014;19:170–8.CrossRef Pant S, Deshmukh A, Gurumurthy GS, Pothineni NV, Watts TE, Romeo F, et al. Inflammation and atherosclerosis--revisited. J Cardiovasc Pharmacol Ther. 2014;19:170–8.CrossRef
11.
go back to reference Chen J, Chen MH, Li S, Guo YL, Zhu CG, Xu RX, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting the severity of coronary artery disease: a Gensini score assessment. J Atheroscler Thromb. 2014;21:1271–82.CrossRef Chen J, Chen MH, Li S, Guo YL, Zhu CG, Xu RX, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting the severity of coronary artery disease: a Gensini score assessment. J Atheroscler Thromb. 2014;21:1271–82.CrossRef
12.
go back to reference Kaya MG, Akpek M, Lam YY, Yarlioglues M, Celik T, Gunebakmaz O, et al. 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;168:1154–9.CrossRef Kaya MG, Akpek M, Lam YY, Yarlioglues M, Celik T, Gunebakmaz O, et al. 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;168:1154–9.CrossRef
13.
go back to reference Guo TM, Cheng B, Ke L, Guan SM, Qi BL, Li WZ, et al. Prognostic value of neutrophil to lymphocyte ratio for in-hospital mortality in elderly patients with acute myocardial infarction. Curr Med Sci. 2018;38:354–9.CrossRef Guo TM, Cheng B, Ke L, Guan SM, Qi BL, Li WZ, et al. Prognostic value of neutrophil to lymphocyte ratio for in-hospital mortality in elderly patients with acute myocardial infarction. Curr Med Sci. 2018;38:354–9.CrossRef
14.
go back to reference Woollard KJ, Geissmann F. Monocytes in atherosclerosis: subsets and functions. Nat Rev Cardiol. 2010;7:77–86.CrossRef Woollard KJ, Geissmann F. Monocytes in atherosclerosis: subsets and functions. Nat Rev Cardiol. 2010;7:77–86.CrossRef
15.
go back to reference Santos-Gallego CG, Picatoste B, Badimon JJ. Pathophysiology of acute coronary syndrome. Curr Atheroscler Rep. 2014;16:401.CrossRef Santos-Gallego CG, Picatoste B, Badimon JJ. Pathophysiology of acute coronary syndrome. Curr Atheroscler Rep. 2014;16:401.CrossRef
16.
go back to reference Eskandarian R, Ghorbani R, Asgary Z. Relationship between leucocytosis and left ventricular ejection fraction in patients with acute myocardial infarction. Singap Med J. 2013;54:40–3.CrossRef Eskandarian R, Ghorbani R, Asgary Z. Relationship between leucocytosis and left ventricular ejection fraction in patients with acute myocardial infarction. Singap Med J. 2013;54:40–3.CrossRef
17.
go back to reference Maekawa Y, Anzai T, Yoshikawa T, Asakura Y, Takahashi T, Ishikawa S, et al. Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction:a possible role for left ventricular remodeling. J Am Coll Cardiol. 2002;39:241–6.CrossRef Maekawa Y, Anzai T, Yoshikawa T, Asakura Y, Takahashi T, Ishikawa S, et al. Prognostic significance of peripheral monocytosis after reperfused acute myocardial infarction:a possible role for left ventricular remodeling. J Am Coll Cardiol. 2002;39:241–6.CrossRef
18.
go back to reference Gijsberts CM, Ellenbroek GH, Ten Berg MJ, Huisman A, van Solinge WW, Asselbergs FW, et al. Routinely analyzed leukocyte characteristics improve prediction of mortality after coronary angiography. Eur J Prev Cardiol. 2016;23:1211–20.CrossRef Gijsberts CM, Ellenbroek GH, Ten Berg MJ, Huisman A, van Solinge WW, Asselbergs FW, et al. Routinely analyzed leukocyte characteristics improve prediction of mortality after coronary angiography. Eur J Prev Cardiol. 2016;23:1211–20.CrossRef
19.
go back to reference Kristono GA, Holley AS, Harding SA, Larsen PD. White blood cell subtypes as predictors of adverse cardiac events. Coron Artery Dis. 2020;31:446–50. Kristono GA, Holley AS, Harding SA, Larsen PD. White blood cell subtypes as predictors of adverse cardiac events. Coron Artery Dis. 2020;31:446–50.
20.
go back to reference Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.CrossRef Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.CrossRef
21.
go back to reference Kiris T, Celik A, Varis E, Akan E, Akyildiz ZI, Karaca M, et al. Association of Lymphocyte-to-Monocyte Ratio with the mortality in patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Angiology. 2017;68:707–15.CrossRef Kiris T, Celik A, Varis E, Akan E, Akyildiz ZI, Karaca M, et al. Association of Lymphocyte-to-Monocyte Ratio with the mortality in patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Angiology. 2017;68:707–15.CrossRef
22.
go back to reference Fan Z, Li Y, Ji H, Jian X. Prognostic utility of the combination of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NSTEMI after primary percutaneous coronary intervention: a retrospective cohort study. BMJ Open. 2018;8:e023459.CrossRef Fan Z, Li Y, Ji H, Jian X. Prognostic utility of the combination of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NSTEMI after primary percutaneous coronary intervention: a retrospective cohort study. BMJ Open. 2018;8:e023459.CrossRef
23.
go back to reference Chen H, Li M, Liu L, Dang XW, Zhu DJ, Tian G. Monocyte/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients with non-ST-elevation myocardial infarction. Medicine. 2019;98:e16267. Chen H, Li M, Liu L, Dang XW, Zhu DJ, Tian G. Monocyte/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients with non-ST-elevation myocardial infarction. Medicine. 2019;98:e16267.
24.
go back to reference Cai M, Liang D, Gao F, Hong X, Feng X, Yang Y, et al. Association of lymphocyte-to-monocyte ratio with the long-term outcome after hospital discharge in patients with ST-elevation myocardial infarction: a retrospective cohort study. Coron Artery Dis. 2020;31:248–54.CrossRef Cai M, Liang D, Gao F, Hong X, Feng X, Yang Y, et al. Association of lymphocyte-to-monocyte ratio with the long-term outcome after hospital discharge in patients with ST-elevation myocardial infarction: a retrospective cohort study. Coron Artery Dis. 2020;31:248–54.CrossRef
25.
go back to reference Wang Q, Ma J, Jiang Z, Wu F, Ping J, Ming L. Association of lymphocyte-to-monocyte ratio with in-hospital and long-term major adverse cardiac and cerebrovascular events in patients with ST-elevated myocardial infarction. Medicine. 2017;96:e7897.CrossRef Wang Q, Ma J, Jiang Z, Wu F, Ping J, Ming L. Association of lymphocyte-to-monocyte ratio with in-hospital and long-term major adverse cardiac and cerebrovascular events in patients with ST-elevated myocardial infarction. Medicine. 2017;96:e7897.CrossRef
26.
go back to reference Kurtul A, Yarlioglues M, Celik IE, Duran M, Elcik D, Kilic A, et al. Association of lymphocyte-to-monocyte ratio with the no-reflow phenomenon in patients who underwent a primary percutaneous coronary intervention for ST-elevation myocardial infarction. Coron Artery Dis. 2015;26:706–12.CrossRef Kurtul A, Yarlioglues M, Celik IE, Duran M, Elcik D, Kilic A, et al. Association of lymphocyte-to-monocyte ratio with the no-reflow phenomenon in patients who underwent a primary percutaneous coronary intervention for ST-elevation myocardial infarction. Coron Artery Dis. 2015;26:706–12.CrossRef
27.
go back to reference Camici PG, Rimoldi OE, Gaemperli O, Libby P. Non-invasive anatomic and functional imaging of vascular inflammation and unstable plaque. Eur Heart J. 2012;33:1309–U1329.CrossRef Camici PG, Rimoldi OE, Gaemperli O, Libby P. Non-invasive anatomic and functional imaging of vascular inflammation and unstable plaque. Eur Heart J. 2012;33:1309–U1329.CrossRef
28.
go back to reference Hofmann U, Frantz S. Role of lymphocytes in myocardial injury, healing, and remodeling after myocardial infarction. Circ Res. 2015;116:354–67.CrossRef Hofmann U, Frantz S. Role of lymphocytes in myocardial injury, healing, and remodeling after myocardial infarction. Circ Res. 2015;116:354–67.CrossRef
29.
go back to reference Hofmann U, Beyersdorf N, Weirather J, Podolskaya A, Bauersachs J, Ertl G, et al. Activation of CD4+ T lymphocytes improves wound healing and survival after experimental myocardial infarction in mice. Circulation. 2012;125:1652–63.CrossRef Hofmann U, Beyersdorf N, Weirather J, Podolskaya A, Bauersachs J, Ertl G, et al. Activation of CD4+ T lymphocytes improves wound healing and survival after experimental myocardial infarction in mice. Circulation. 2012;125:1652–63.CrossRef
30.
go back to reference Ruparelia N, Godec J, Lee R, Chai JT, Dall'Armellina E, McAndrew D, et al. Acute myocardial infarction activates distinct inflammation and proliferation pathways in circulating monocytes, prior to recruitment, and identified through conserved transcriptional responses in mice and humans. Eur Heart J. 2015;36:1923–34.CrossRef Ruparelia N, Godec J, Lee R, Chai JT, Dall'Armellina E, McAndrew D, et al. Acute myocardial infarction activates distinct inflammation and proliferation pathways in circulating monocytes, prior to recruitment, and identified through conserved transcriptional responses in mice and humans. Eur Heart J. 2015;36:1923–34.CrossRef
31.
go back to reference Dutta P, Nahrendorf M. Monocytes in myocardial infarction. Arterioscler Thromb Vasc Biol. 2015;35:1066–70.CrossRef Dutta P, Nahrendorf M. Monocytes in myocardial infarction. Arterioscler Thromb Vasc Biol. 2015;35:1066–70.CrossRef
Metadata
Title
The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: a systematic review and meta-analysis
Authors
Xiao-Qing Quan
Run-Chang Wang
Qing Zhang
Cun-Tai Zhang
Lei Sun
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2020
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-020-01614-x

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