Coronary artery diseaseUsefulness of Neutrophil to Lymphocyte Ratio in Predicting Short- and Long-Term Mortality After Non–ST-Elevation Myocardial Infarction
Section snippets
Methods
This retrospective longitudinal observational study explored the predictive value of NLR on short- and long-term survival in 1,345 patients with NSTEMI discharged from Staten Island University Hospital (Staten Island, New York), the only angioplasty-providing tertiary center in Staten Island, with a semi-isolated population of 443,728 (77.6% white Americans), from September 2004 to September 2006. Study inclusion required a cardiologist-confirmed NSTEMI diagnosis with a documented gradual
Results
All-cause 4-year mortality was the primary outcome. Of the 619 patients with NSTEMI, 108 (17.3%) deaths occurred. Figure 2 illustrates significant higher in-hospital, 6-month, and 4-year mortalities (8.7%, 14.4%, and 29.8% respectively) in third-tertile patients compared to those in first tertile (1%, 3%, and 8.4% respectively, Mantel-Haenszel chi-square 32.69, p <0.0001). Four-year Kaplan-Meier curves indicate that patients in the highest average NLR tertile had significantly worse
Discussion
In our study, average NLR was a stronger independent predictor of short- and-long term survival than other leukocyte parameters. The predictive superiority of NLR may be due to 2 factors. First, common physiologic conditions (e.g., dehydration) and in vitro handling of blood specimens may affect the absolute number of individual subtypes of white blood cells more than NLR. For example, exercise and catecholamine increase neutrophil and lymphocyte counts,9, 10 affecting to a lesser degree the
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