title: Relationship between neutrophil-to-lymphocyte ratio and electrocardiographic ischemia grade in STEMI.
abstract: BACKGROUND
  Neutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Changes in the QRS terminal portion have also been associated with adverse outcomes following STEMI.
  
  
  OBJECTIVE
  To investigate the relationship between ECG ischemia grade and NLR in patients presenting with STEMI, in order to determine additional conventional risk factors for early risk stratification.
  
  
  METHODS
  Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG performed on admission. White blood cells and subtypes were measured as part of the automated complete blood count (CBC) analysis. Patients were classified into two groups according to the ischemia grade presented on the admission ECG, as grade 2 ischemia (G2I) and grade 3 ischemia (G3I).
  
  
  RESULTS
  Patients with G3I had significantly lower mean left ventricular ejection fraction than those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital mortality rate increased proportionally with the increase in ischemia grade (p = 0.036). There were significant differences in percentage of lymphocytes (p = 0.010) and percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis revealed that only NLR was the independent variable with a significant effect on ECG ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120-1.403, p < 0.001).
  
  
  CONCLUSIONS
  We found an association between G3I and elevated NLR in patients with STEMI. We believe that such an association might provide an additional prognostic value for risk stratification in patients with STEMI when combined with standardized risk scores.
authors.affiliation: Department of Cardiology, Aksaz Military Hospital.
authors.forename: Emre
authors.initials: E
authors.lastname: Yalcinkaya
authors.affiliation: Department of Cardiology, School of Medicine, Gulhane Military Medical Academy.
authors.forename: Uygar Cagdas
authors.initials: UC
authors.lastname: Yuksel
authors.affiliation: Department of Cardiology, School of Medicine, Gulhane Military Medical Academy.
authors.forename: Murat
authors.initials: M
authors.lastname: Celik
authors.affiliation: Department of Cardiology, School of Medicine, Gulhane Military Medical Academy.
authors.forename: Hasan Kutsi
authors.initials: HK
authors.lastname: Kabul
authors.affiliation: Department of Cardiology, School of Medicine, Gulhane Military Medical Academy.
authors.forename: Cem
authors.initials: C
authors.lastname: Barcin
authors.affiliation: Department of Cardiology, School of Medicine, Gulhane Military Medical Academy.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Gokoglan
authors.affiliation: Department of Cardiology, School of Medicine, Gulhane Military Medical Academy.
authors.forename: Erkan
authors.initials: E
authors.lastname: Yildirim
authors.affiliation: Department of Cardiology, School of Medicine, Gulhane Military Medical Academy.
authors.forename: Atila
authors.initials: A
authors.lastname: Iyisoy
mesh_terms: D000368:Aged; D004562:Electrocardiography / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000097:blood* / Q000503:physiopathology; D009504:Neutrophils; D011237:Predictive Value of Tests; D011379:Prognosis; D012016:Reference Values; D012720:Severity of Illness Index