Roles of the red cell distribution width and neutrophil/lymphocyte ratio in predicting thrombolysis failure in patients with an ST-segment elevation myocardial infarction.
Red cell distribution width (RDW) and the neutrophil/lymphocyte ratio (NLR) are predictors of cardiovascular risk that have been shown to correlate with impaired reperfusion and increased morbidity and mortality in patients with an ST-segment elevation myocardial infarction (STEMI). We hypothesized that RDW and the NLR would be associated with failed thrombolysis. One hundred and two STEMI patients were included in the study; 32 had failed thrombolysis while the other 70 fulfilled the criteria for successful thrombolysis. Thrombolysis failure was defined as a need for rescue percutaneous coronary intervention (PCI), in-hospital mortality, unplanned PCI during hospitalization or complete occlusion of the culprit coronary artery on follow-up angiography. RDWs were compared between patients with failed or successful thrombolysis. There were no significant differences in the demographic or clinical baseline characteristics of the two groups. The mean RDW was significantly higher in the failed thrombolysis group than in the successful thrombolysis group (P = 0.028). The cutoff RDW value for failed thrombolysis was more than 14.3 fl with a sensitivity of 90.6% and a specificity of 61.4% (area under the curve, 0.774; 95% confidence interval, 0.680-0.851; P < 0.001) on receiver operating characteristics curve analysis. In addition, the prevalence of failed thrombolysis was significantly higher in patients with an RDW more than 14.3 fl than in those with an RDW of 14.3 fl or less (51.8 and 6.5%, respectively, P < 0.001 by multivariate analysis). The NLR was significantly higher in patients with an RDW more than 14.3 fl than in those with an RDW 14.3 fl or less (4 ± 2.5 and 2.8 ± 1.5, respectively, P = 0.007). RDW and the NLR may be used as adjunctive readily available factors for assessment of thrombolysis outcome upon admission.
aDepartment of Cardiology, Diyarbakır Gazi Yaşargil Education and Research Hospital bDepartment of Cardiology, Adıyaman University cDepartment of Cardiovascular Surgery, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey.
Erkan
E
Baysal
Mustafa
M
Çetin
Barş
B
Yaylak
Bernas
B
Altntaş
Rojhat
R
Altndağ
Şahin
Ş
Adyaman
Yakup
Y
Altaş
İlyas
İ
Kaya
Utkan
U
Sevuk
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D000077144:Clopidogrel; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004909:Erythrocyte Indices; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D009504:Neutrophils; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016879:Salvage Therapy; D012680:Sensitivity and Specificity; D000077785:Tenecteplase; D015912:Thrombolytic Therapy; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D017211:Treatment Failure
D005343:Fibrinolytic Agents; D000077144:Clopidogrel; D010959:Tissue Plasminogen Activator; D013988:Ticlopidine; D001241:Aspirin; D000077785:Tenecteplase