title: Neutrophil to lymphocyte ratio is associated with more extensive, severe and complex coronary artery disease and impaired myocardial perfusion.
abstract: OBJECTIVE
  We investigated the relation between neutrophil to lymphocyte ratio (N/L) and the extent, severity, and complexity of coronary artery disease (CAD) and myocardial perfusion.
  
  
  METHODS
  One hundred and fifty-one patients who underwent coronary angiography with stable angina pectoris (SAP) (n=93) or acute coronary syndrome (ACS) (n=58) were included in the study. Blood samples were drawn before coronary angiography. Gensini and SYNTAX scores and myocardial blush grade (MBG) were assessed.
  
  
  RESULTS
  Neutrophil counts were 4.4±1.4 and 5.0±1.6 in the SAP and ACS groups (p=0.018), whereas lymphocyte counts were 2.2±0.7 and 2.1±0.7, respectively (p=0.104). N/L was 2.2±1.2 in the SAP and 2.6±1.0 in the ACS (p=0.002) groups. In patients with SAP, N/L was significantly correlated with Gensini and SYNTAX scores (Gensini score r=0.32, p=0.002; SYNTAX score r=0.36, p=0.000), but there was no significant correlation between N/L and MBG. In the ACS group, N/L had a more powerful association with both Gensini and SYNTAX scores (Gensini r=0.42, p=0.001; SYNTAX r=0.51, p=0.000). N/L was negatively correlated with MBG in ACS patients (r= -0.48, p=0.000). Significant correlations persisted both in the SAP and ACS groups after correcting for age, diabetes, hyperlipidemia, and statin use; however, the associations were weaker. Cut-off N/L to predict moderate to severe CAD according to SYNTAX score was 2.26, with 72% sensitivity and 71% specificity (area under the curve [AUC]: 0.772, 95% confidence interval [CI] 0.679-0.865, p<0.001).
  
  
  CONCLUSIONS
  N/L is associated with severe, extensive and complex CAD and may be used to predict moderate to severe involvement in patients with CAD.
authors.affiliation: Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, Turkey. aslitanindi@gmail.com.
authors.forename: Aslı
authors.initials: A
authors.lastname: Tanındı
authors.affiliation: Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, Turkey.
authors.forename: Aycan Fahri
authors.initials: AF
authors.lastname: Erkan
authors.affiliation: Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, Turkey.
authors.forename: Berkay
authors.initials: B
authors.lastname: Ekici
authors.affiliation: Department of Statistics, Ufuk University Faculty of Arts and Sciences, Ankara, Turkey.
authors.forename: Aslıhan
authors.initials: A
authors.lastname: Alhan
authors.affiliation: Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, Turkey.
authors.forename: Hasan Fehmi
authors.initials: HF
authors.lastname: Töre
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood; D009504:Neutrophils / Q000473:pathology*
chemical_list: D015415:Biomarkers