title: The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention.
abstract: OBJECTIVE
  In the present study we aimed to reveal any probable correlation between neutrophil-to-lymphocyte ratio (N/L ratio) and the occurrence of no-reflow, along with assessment of the prognostic value of N/L ratio in patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  The N/L ratio stands practically for the balance between neutrophil and lymphocyte counts in the body, which can also be utilized as an index for systemic inflammatory status.
  
  
  METHODS
  In our study, we included 204 consecutive patients suffering from STEMI who underwent primary percutaneous coronary intervention (PCI). Patients with STEMI were assigned into distinct tertiles based on their N/L ratios on admission. No-reflow encountered following PCI was evaluated through both angiography [Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade (MBG)] and electrocardiography (as ST-segment resolution).
  
  
  RESULTS
  Patients featured with no ST-resolution were documented to have displayed significantly higher N/L ratio on admission compared to those with intermediate or complete ST-segment resolution. The number of the patients characterized with no-reflow, evident both angiographically (TIMI flow ≤ 2 or TIMI flow 3 with final myocardial bush grade ≤ 2 after PCI) and electrocardiographically (ST-resolution <30%), was encountered to depict increments throughout successive N/L ratio tertiles. Moreover, the same also held true for three-year mortality rates across the tertile groups (9% vs. 15% vs. 35%, p < 0.01). Multivariable logistic regression analysis disclosed that N/L ratio on admission stood for a significant indicator for long-term mortality in patients with no-reflow phenomenon detected with MBG. Elevated N/L ratio on admission was also found to be a significant indicator for three-year mortality and major adverse cardiac events.
  
  
  CONCLUSIONS
  In patients with STEMI who underwent primary PCI, elevated N/L ratios on admission were revealed to be correlated with both no-reflow phenomenon and long-term prognosis.
authors.affiliation: Department of Cardiology, Mustafa Kemal University, Tayfur Ata Sokmen Medical School, 06270 Hatay, Turkey. nihatdrsen@gmail.com
authors.forename: Nihat
authors.initials: N
authors.lastname: Sen
authors.forename: Baris
authors.initials: B
authors.lastname: Afsar
authors.forename: Firat
authors.initials: F
authors.lastname: Ozcan
authors.forename: Eyup
authors.initials: E
authors.lastname: Buyukkaya
authors.forename: Ahmet
authors.initials: A
authors.lastname: Isleyen
authors.forename: Adnan Burak
authors.initials: AB
authors.lastname: Akcay
authors.forename: Huseyin
authors.initials: H
authors.lastname: Yuzgecer
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kurt
authors.forename: Mehmet Fatih
authors.initials: MF
authors.lastname: Karakas
authors.forename: Nurcan
authors.initials: N
authors.lastname: Basar
authors.forename: Edjon
authors.initials: E
authors.lastname: Hajro
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kanbay
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000276:immunology / Q000401:mortality / Q000628:therapy; D009504:Neutrophils / Q000166:cytology*; D054318:No-Reflow Phenomenon / Q000276:immunology / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve