title: Neutrophil-to-lymphocyte ratio as an independent predictor of left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Patients with acute coronary syndrome due to left main and/or three-vessel disease (LM/3VD) are at the highest risk of short- and long-term adverse cardiovascular events. Neutrophil-to-lymphocyte ratio (NLR) has been shown to predict the severity of coronary artery disease in various clinical settings, but its independent predictive value for LM/3VD has not been investigated in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to evaluate the independent predictive value of NLR for LM/3VD in NSTEMI patients.
  
  
  METHODS
  We performed a retrospective analysis of consecutive NSTEMI patients who underwent coronary angiography. NLR was calculated as the ratio of neutrophil to lymphocyte based on the laboratory data on admission. The primary outcome was the presence of LM/3VD.
  
  
  RESULTS
  In all, 396 patients were included in the final analysis. Median NLR in the entire study population was 3.43 (interquartile range, 2.12-5.51). By receiver operating characteristics curve analysis, the optimal cutoff value of NLR in predicting LM/3VD was 2.80 (area under the curve 0.60, sensitivity 73%, specificity 43%). Of the 396 patients, 244 patients (62%) had NLR ≥2.8. Patients with NLR ≥2.8 were older and had a higher prevalence of LM/3VD (30 % vs. 18%, p=0.005). According to multivariate logistic regression analysis, NLR ≥2.8 was an independent predictor of LM/3VD after adjusting for other clinical variables including ST depression and ST elevation in lead aVR (odds ratio 1.83, 95% confidence interval 1.07-3.21, p=0.03).
  
  
  CONCLUSIONS
  Our study demonstrates that NLR ≥2.8 is an independent predictor of LM/3VD in patients with NSTEMI.
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, NY, USA. Electronic address: nmisumida@chpnet.org.
authors.forename: Naoki
authors.initials: N
authors.lastname: Misumida
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, NY, USA.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, NY, USA.
authors.forename: Madeeha
authors.initials: M
authors.lastname: Saeed
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, NY, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Fox
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, NY, USA.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications* / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications* / Q000000981:diagnostic imaging; D009504:Neutrophils / Q000378:metabolism*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: Left main disease; Neutrophil-to-lymphocyte ratio; Non-ST-segment elevation myocardial infarction; Three-vessel disease