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Background: The potential prognostic biomarker—neutrophil to lymphocyte ratio (NLR) can be used to predict the severity of STEMI. We conducted an observational study using this parameter together with the extent of coronary artery involvement from coronary angiogram and magnitude of ST-elevation on ECG to determine the prognosis and the length of hospital stay. The effect of early reperfusion with thrombolysis was also observed.
Methods and Results: 30 subjects (age 56.43 ± 13.98), with ST-elevation on ECG at admission, treated with streptokinase and undergoing angiogram were taken for the study. Repeated ECGs and complete blood picture on admission day, day 3, day of discharge and on the follow-up day were obtained. Out of 30 subjects, 15 received thrombolysis out of which 12 (80%) survived compared to the other 15 subjects who presented late, out of which 10 (66.6%) survived. Mean ST-elevation on the day of admission, on day 3, day of discharge and on follow up was found to be 0.39 ± 0.12, 0.18 ± 0.12, 0.05 ± 0.07, 0.00 ± 0.00 respectively. NLR values on admission day were 7.89 ± 4.98, day 3 (6.24 ± 5.05), day of discharge (4.34 ± 2.74) and on follow up (1.71 ± 1.40) indicating association of higher NLR values with magnitude of current of injury. NLR values as high as 18.5 were observed in expired subjects. The length of hospital stay was found to be 6.43 ± 5.03 days.
Conclusion: There was a linear decrement in ST-segment resolution with a decrease in NLR and can be attributed to the natural course of disease and type of intervention provided. Nevertheless, the univariate correlation between ECG and NLR on various days of treatment was not significant.
Montecucco F, Carbone F, Schindler TH. Pathophysiology of ST-segment elevation myocardial infarction: novel mechanisms and treatments. Eur Heart J. 2016;37(16): 1268-83.
Kaya H, Ertaş F, İslamoğlu Y, Kaya Z, Atılgan ZA, Çil H, Çalışkan A, Aydın M, Oylumlu M, Soydinç MS. Association between neutrophil to lymphocyte ratio and severity of coronary artery disease. Clin Appl Thromb Hemost. 2014;20(1):50-4.
Salehi N, Azam H, Bahremand M. Relationship between neutrophil-to-lymphocyte ratio and number of diseased coronary arteries in patients underwent coronary angiography in Imam Ali Hospital, Kermanshah, Iran, 2012-14. Acta Medica Mediterranea. 2016; 32(Spl iss 2):947-52.
Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, Shevach A, Berliner S, Herz I, Keren G, Banai S. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis. 2012;225(2): 456-60.
Sharma K, Patel AK, Shah KH, Konat A. Is neutrophil-to-lymphocyte ratio a predictor of coronary artery disease in Western Indians? Int J Inflam. 2017:4136126.
Akyel A, Yayla Ç, Erat M, Çimen T, Doğan M, Açıkel S, Aydoğdu S, Yeter E. Neutrophil-to-lymphocyte ratio predicts hemodynamic significance of coronary artery stenosis. Anatol J Cardiol. 2015; 15(12):1002-7.
Xu N, Tang XF, Yao Y, Zhao X, Chen J, Gao Z, Yang Y, Gao RL, Xu B, Yuan JQ. Predictive value of neutrophil to lymphocyte ratio in long-term outcomes of left main and/or three-vessel disease in patients with acute myocardial infarction. Catheter Cardiovasc Interv. 2018;91(S1): 551-7.
Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M; ESC Committee for Practice Guidelines (CPG). Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909-45.
Schröder R, Wegscheider K, Schröder K, Dissmann R, Meyer-Sabellek W. Extent of early ST segment elevation resolution: A strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens. A substudy of the International Joint Efficacy Comparison of Thrombolytics (INJECT) trial. J Am Coll Cardiol. 1995;26(7):1657-64.
Sheng F, Chen B, He M, Zhang M, Shen G. Neutrophil to lymphocyte ratio is related to electrocardiographic sign of spontaneous reperfusion in patients with ST-segment elevation myocardial infarction. Arch Med Res. 2016;47(3):180-5.
Ramya NS, Narendra JB, Raghavulu BV, Babu MS, Teja ND, Malini KP, Prathap SS. Assess the clinical efficacy of streptokinase in thrombolysed patients of acute ST segment elevation myocardial infarction. J Young Pharm. 2018;10(3): 330-3.
Kilic S, Kocabas U, Can LH, Yavuzgil O, Zoghi M. The severity of coronary arterial stenosis in patients with acute ST-elevated myocardial infarction: A thrombolytic therapy study. Cardiol Res. 2018;9(1):11-16.
Vakili H, Shirazi M, Charkhkar M, Khaheshi I, Memaryan M, Naderian M. Correlation of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with thrombolysis in myocardial infarction frame count in ST-segment elevation myocardial infarction. Eur J Clin Invest. 2017;47(4):322-7.
Dentali F, Nigro O, Squizzato A, Gianni M, Zuretti F, Grandi AM, Guasti L. Impact of neutrophils to lymphocytes ratio on major clinical outcomes in patients with acute coronary syndromes: A systematic review and meta-analysis of the literature. Int J Cardiol. 2018;266:31-37.
Millard MA, Nagarajan V, Kohan LC, Schutt RC, Keeley EC. Initial electrocardiogram as determinant of hospital course in ST elevation myocardial infarction. Ann Noninvasive Electrocardiol. 2017;22(4):e12429