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Abstract
Background: Plaque instability in acute coronary syndrome (ACS) is mediated by inflammation, and the neutrophil-to-lymphocyte ratio (NLR) is a economical measure of systemic inflammation that may have prognostic utility.
Objectives: To identify how often raised NLR occurs, and how it relates to inflammatory (CRP) and myocardial necrosis (troponin I, CK-MB) markers in patients with ACS.
Methods: Cross-sectional study at the Rehmatul Lil Alameen Institute of Cardiology; 138 consecutive ACS patients were recruited. CBC-derived NLR, CRP, troponin I and CK-MB were measured in admission blood samples, with pre-specified cutoff values: NLR > 2.3852, CRP > 11 mg/L, troponin I ≥ 40 ng/L and CK-MB ≥ 4 U/L as specified in the protocol.
Findings: NLR increase was found in 86/138 (62.3) patients; CRP, troponin I and CK-MB in 62/138 (44.9), 94/138 (68.1) and 76/138 (55.1), respectively. An increase in NLR were significantly correlated with increased troponin I ( 2 p < 0.001; OR 7.5, 95% CI 3.317.0) as well as C+RP and CK-MB ( p < 0.01). NLR was positively correlated with CRP (= 0.52) and troponin I (= 0.46). ROC analysis revealed a fair discrimination about NLR on high troponin (AUC 0.72).
Conclusion: Acute Coronary Syndrome (ACS) is characterized by an elevated neutrophil-to-lymphocyte ratio (NLR), which is associated with inflammatory responses and myocardial necrosis. As an inexpensive and readily available biomarker, NLR can serve as an effective adjunct to initial risk stratification. However, its utility should be prospectively validated through further studies.