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open access

Vol 30, No 1 (2023)
Original Article
Submitted: 2020-03-01
Accepted: 2020-12-31
Published online: 2021-01-11
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Incremental predictive value of the combined use of the neutrophil-to-lymphocyte ratio and systolic blood pressure difference after successful drug-eluting stent implantation

Yong Hoon Kim1, Ae-Young Her1, Scot Garg2, Eun-Seok Shin3
DOI: 10.5603/CJ.a2021.0004
·
Pubmed: 33438177
·
Cardiol J 2023;30(1):91-104.
Affiliations
  1. Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
  2. East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom
  3. Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Republic of Korea

open access

Vol 30, No 1 (2023)
Original articles — Clinical cardiology
Submitted: 2020-03-01
Accepted: 2020-12-31
Published online: 2021-01-11

Abstract

Background: Previous work has highlighted the importance of the neutrophil-to-lymphocyte ratio (NLR) and the difference in the ward-to-catheterization laboratory systolic blood pressure (ΔSBP) in prognostic stratification after acute coronary syndrome. However, there is paucity of data regarding the added value of combining these two variables to predict 5-year major clinical outcomes after percutaneous coronary intervention. Methods: A total of 1188 patients were classified into four groups according to the NLR and ΔSBP (high vs. low) using cutoffs derived from an analysis of receiver operating characteristic curves. A NLR > 3.0 and a ΔSBP > 25 mmHg were considered high values. The primary endpoint was the composite of all-cause death, cardiac death, and non-fatal myocardial infarction. The secondary endpoint was the composite of target lesion revascularization, target vessel revascularization, and incidence of cerebrovascular accidents. Results: The incidence of the primary endpoint was significantly higher in the high NLR and ΔSBP group than in the other three groups (2.2% vs. 4.7% vs. 4.3% vs. 13.2%, p < 0.001). The incidence of the secondary endpoint was similar among the four groups. Incorporation of high NLR and high ΔSBP into a model with conventional and meaningful clinical and procedural risk factors increased the C-statistics in predicting the primary endpoint (0.575 to 0.635, p = 0.002). Conclusions: The power to predict the primary endpoint after drug-eluting stent implantation at the 5-year follow-up was improved by combining NLR and ΔSBP.

Abstract

Background: Previous work has highlighted the importance of the neutrophil-to-lymphocyte ratio (NLR) and the difference in the ward-to-catheterization laboratory systolic blood pressure (ΔSBP) in prognostic stratification after acute coronary syndrome. However, there is paucity of data regarding the added value of combining these two variables to predict 5-year major clinical outcomes after percutaneous coronary intervention. Methods: A total of 1188 patients were classified into four groups according to the NLR and ΔSBP (high vs. low) using cutoffs derived from an analysis of receiver operating characteristic curves. A NLR > 3.0 and a ΔSBP > 25 mmHg were considered high values. The primary endpoint was the composite of all-cause death, cardiac death, and non-fatal myocardial infarction. The secondary endpoint was the composite of target lesion revascularization, target vessel revascularization, and incidence of cerebrovascular accidents. Results: The incidence of the primary endpoint was significantly higher in the high NLR and ΔSBP group than in the other three groups (2.2% vs. 4.7% vs. 4.3% vs. 13.2%, p < 0.001). The incidence of the secondary endpoint was similar among the four groups. Incorporation of high NLR and high ΔSBP into a model with conventional and meaningful clinical and procedural risk factors increased the C-statistics in predicting the primary endpoint (0.575 to 0.635, p = 0.002). Conclusions: The power to predict the primary endpoint after drug-eluting stent implantation at the 5-year follow-up was improved by combining NLR and ΔSBP.

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Keywords

blood pressure difference, drug-eluting stent, neutrophil-to-lymphocyte ratio, outcomes, percutaneous coronary intervention

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Supplemental Online Material 1. Cumulative clinical events at 2 years.
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About this article
Title

Incremental predictive value of the combined use of the neutrophil-to-lymphocyte ratio and systolic blood pressure difference after successful drug-eluting stent implantation

Journal

Cardiology Journal

Issue

Vol 30, No 1 (2023)

Article type

Original Article

Pages

91-104

Published online

2021-01-11

Page views

3567

Article views/downloads

671

DOI

10.5603/CJ.a2021.0004

Pubmed

33438177

Bibliographic record

Cardiol J 2023;30(1):91-104.

Keywords

blood pressure difference
drug-eluting stent
neutrophil-to-lymphocyte ratio
outcomes
percutaneous coronary intervention

Authors

Yong Hoon Kim
Ae-Young Her
Scot Garg
Eun-Seok Shin

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