title: Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention: a prospective, multicenter study.
abstract: OBJECTIVE
  The pre-procedural neutrophil to lymphocyte ratio (N/L) is associated with adverse outcomes among patients with coronary artery disease but its prognostic value in ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. This study evaluated the relations between pre-procedural N/L ratio and the in-hospital and long-term outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  A total of 682 STEMI patients presented within the first 6h of symptom onset were enrolled and stratified according to tertiles of N/L ratio based on the blood samples obtained in the emergency room upon admission.
  
  
  RESULTS
  The mean follow-up period was 43.3 months (1-131 months). In-hospital in-stent thrombosis, non-fatal myocardial infarction, and cardiovascular mortality increased as the N/L tertile ratio increased (p<0.001, p<0.001, p=0.003, respectively). Long-term in-stent thrombosis, non-fatal myocardial infarction and cardiovascular mortality also increased as the N/L ratio increased (p<0.001, p<0.001, p=0.002, respectively). On multivariate analysis, N/L ratio remained an independent predictor for both in-hospital (OR 1.189, 95% CI 1.000-1.339; p<0.001) and long-term major (OR 1.228, 95% CI 1.136-1.328; p<0.001) adverse cardiac events.
  
  
  CONCLUSIONS
  The N/L ratio was an independent predictor of both in-hospital and long-term adverse outcomes among STEMI patients undergoing primary PCI. Our findings suggest that this inexpensive, universally available hematological marker may be incorporated into the current established risk assessment model for STEMI.
authors.affiliation: Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey.
authors.forename: Mehmet G
authors.initials: MG
authors.lastname: Kaya
authors.forename: Mahmut
authors.initials: M
authors.lastname: Akpek
authors.forename: Yat Yin
authors.initials: YY
authors.lastname: Lam
authors.forename: Mikail
authors.initials: M
authors.lastname: Yarlioglues
authors.forename: Turgay
authors.initials: T
authors.lastname: Celik
authors.forename: Ozgur
authors.initials: O
authors.lastname: Gunebakmaz
authors.forename: Mustafa
authors.initials: M
authors.lastname: Duran
authors.forename: Seref
authors.initials: S
authors.lastname: Ulucan
authors.forename: Ahmet
authors.initials: A
authors.lastname: Keser
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Oguzhan
authors.forename: Michael C
authors.initials: MC
authors.lastname: Gibson
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D009504:Neutrophils / Q000378:metabolism*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome