Value of early risk stratification using hemoglobin level and neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Complete blood count is the most widely available laboratory datum in the early in-hospital period after ST-elevation myocardial infarction (STEMI). We assessed the clinical utility of the combined use of hemoglobin (Hb) level and neutrophil-to-lymphocyte ratio (N/L) for early risk stratification in patients with STEMI. We analyzed 801 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) within 12 hours of onset of symptoms. Patients with cardiogenic shock or underlying malignancy were excluded, and 739 patients (63 ± 13 years, 74% men) were included in the final analysis. Patients were categorized into 3 groups using the median value of N/L (3.86) and the presence of anemia (Hb <13 mg/dl in men and <12 mg/dl in women); group I had low N/L and no anemia (n = 272), group II had low N/L and anemia, or high N/L and no anemia (n = 331), and group III had high N/L and anemia (n = 136). There were significant differences on clinical outcomes during 6-month follow-up among the 3 groups. Prognostic discriminatory capacity of combined use of Hb level and N/L was also significant in high-risk subgroups such as patients with advanced age, diabetes mellitus, multivessel coronary disease, low ejection fraction, and even in those having higher mortality risk based on Thrombolysis In Myocardial Infarction risk score. In a Cox proportional hazards model, after adjusting for multiple covariates, group III had higher mortality at 6 months (hazard ratio 5.6, 95% confidence interval 1.1 to 27.9, p = 0.036) compared to group I. In conclusion, combined use of Hb level and N/L provides valuable timely information for early risk stratification in patients with STEMI undergoing primary PCI.
Chonnam National University, Gwangju, Republic of Korea.
Kyung Hoon
KH
Cho
Myung Ho
MH
Jeong
Khurshid
K
Ahmed
Daisuke
D
Hachinohe
Hong Sang
HS
Choi
Soo Young
SY
Chang
Min Chul
MC
Kim
Seung Hwan
SH
Hwang
Keun-Ho
KH
Park
Min Goo
MG
Lee
Jum Suk
JS
Ko
Doo Sun
DS
Sim
Nam Sik
NS
Yoon
Hyun Ju
HJ
Yoon
Young Joon
YJ
Hong
Kye Hun
KH
Kim
Ju Han
JH
Kim
Youngkeun
Y
Ahn
Jeong Gwan
JG
Cho
Jong Chun
JC
Park
Jung Chaee
JC
Kang
D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000628:therapy; D009504:Neutrophils; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment
D015415:Biomarkers; D006454:Hemoglobins