Coronary Artery Disease
Association of Platelet-to-Lymphocyte Ratio With Severity and Complexity of Coronary Artery Disease in Patients With Acute Coronary Syndromes

https://doi.org/10.1016/j.amjcard.2014.07.005Get rights and content

Highlights

The SXscore is an anatomic scoring system based on CA that quantifies lesion severity and complexity and predicts poor cardiovascular outcomes, including mortality, in patients with ACS. The PLR is a new inflammatory marker and predictor of major adverse outcomes in patients with cardiovascular diseases. A total of 1,016 patients with ACS who underwent urgent CA were included in this study. The PLR at admission was significantly associated with the severity and complexity of coronary atherosclerosis in patients with ACS. Independent predictors of in-hospital mortality were PLR together with LVEF and SXscore in multivariate analysis.

The SYNTAX score (SXscore) is an anatomic scoring system based on coronary angiography (CA) that not only quantifies lesion severity and complexity but also predicts poor cardiovascular outcomes, including mortality, in patients with acute coronary syndromes (ACS). Recent studies have shown that platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in many cardiovascular diseases. The aim of this study was to investigate the association of PLR with the severity and complexity of coronary atherosclerosis as assessed by the SXscore in patients with ACS who underwent urgent CA. A total of 1,016 patients with ACS who underwent urgent CA were included in the study from August 2012 to March 2014. Admission PLR values were calculated before CA was performed. The SXscore was determined from baseline CA. The patients were divided into 2 groups, those with low SXscores (≤22) and those with intermediate to high SXscores (≥23). PLRs were significantly higher in patients with intermediate to high SXscores compared with those with low SXscores (p <0.001). In-hospital mortality was significantly higher in the groups with high PLR and intermediate to high SXscores. In multivariate analysis, the independent predictors of intermediate to high SXscore were PLR (odds ratio 1.018, 95% confidence interval 1.013 to 1.023, p <0.001) together with the left ventricular ejection fraction (odds ratio 0.935, 95% confidence interval 0.910 to 0.960, p <0.001), and age (odds ratio 1.029, 95% confidence interval 1.029 to 1.054, p = 0.02). A PLR ≥116 had 71% sensitivity and 66% specificity in predicting intermediate to high SXscore. In conclusion, the PLR at admission is significantly associated with the severity and complexity of coronary atherosclerosis in patients with ACS. Increased PLR is an independent predictor of higher SXscore in patients with ACS who undergo urgent CA.

Section snippets

Methods

From July 2012 to March 2014, consecutive patients who were hospitalized at our institution because of ACS, who underwent urgent CA after diagnosis, were enrolled in our study.

Initially 1,049 patients were admitted for analysis. Thirty-three patients were excluded from the study for the following reasons: 6 patients were excluded because of unavailability of laboratory data, 2 patients had histories of malignancy, 18 patients had histories of coronary artery bypass grafting, 5 patients had

Results

A total of 1,016 patients with ACS who underwent urgent CA were enrolled in the study. The mean age was 61.4 ± 12.9 years, and 286 of the patients (28.1%) were women. While 678 patients (66.7%) had low SXscores (≤22), 338 patients (33.3%) had intermediate to high SXscores (≥23).

Differences in the baseline clinical and angiographic characteristics in patients with low and intermediate to high SXscores are listed in Table 1. Previous medications, including antithrombotic treatment (aspirin and/or

Discussion

In the present study, we have shown that PLR at admission is an independent predictor of the prevalence of more complex coronary artery lesions (SXscore ≥23) in patients with ACS. In addition, our study has shown that PLR and SXscore predict in-hospital mortality in patients with ACS.

The SXscore is an anatomic scoring system based on CA that quantifies lesion severity and complexity and predicts poor cardiovascular outcomes, including mortality, in patients with ACS. In a previous study,

Disclosures

The authors have no conflicts of interest to disclose.

References (30)

  • T. Palmerini et al.

    Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial

    J Am Coll Cardiol

    (2011)
  • M. Magro et al.

    Usefulness of the SYNTAX score to predict “no reflow” in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

    Am J Cardiol

    (2012)
  • S.P. Thomson et al.

    Endogenous cortisol: a regulator of the number of lymphocytes in peripheral blood

    Clin Immunol Immunopathol

    (1980)
  • G. Huang et al.

    Coronary score adds prognostic information for patients with acute coronary syndrome

    Circ J

    (2010)
  • G. Sianos et al.

    The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease

    Eurointervention

    (2005)
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