The prognostic value of neutrophil-to-lymphocyte ratio across all stages of coronary artery disease

Abstract

The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor longterm outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.

Association of Derived Neutrophil-To-Lymphocyte Ratio With Prognosis of Coronary Heart Disease After PCI

“…Recently, Agarwal et al (25) reviewed the prognostic value of NLR across all stages of CHD. In the review of Agarwal, three studies (26-28) reported that higher NLR was associated with increased risk of all-cause death or cardiac death.…”

“…Several mechanistic pathways may connect NLR to adverse prognosis in CHD patients. First, previous studies (25,31)suggested that increased neutrophils can result in the production of vascular endothelial growth factor (VEGF), IL-1, IL-6, and IL-17, which all were reported to be associated with adverse outcomes of CHD. Second, lymphocytes have been suggested to play a role in the modulation of the inflammatory response throughout the atherosclerotic process (32).…”

The Early Predictive Value of Circulating Monocytes and Eosinophils in Coronary DES Restenosis

“…Several studies have investigated whether laboratory parameters of complete blood count or biochemical analysis could predict ISR, but yielded inconsistent results (6)(7)(8)(9)(10)(11)(12). Moreover, previous studies only employed bare-metal stent (BMS) and blood samples from the peri-interventional period and did not supplement with a dynamic follow-up.…”

Neutrophil to Lymphocyte Ratio (NLR) as an Easily Accessible Parameter for Monitoring Tacrolimus Overdose after Heart Transplantation—Experimental Study

“…Neutrophil to lymphocyte ratio (NLR) is a simple marker of inflammatory reactions activation and has been postulated to play a clinical role as a predictive marker in oncology and cardiology [ 5 , 6 , 7 , 8 , 9 ]. The relationship between low values of NLR and rejection episodes in corneal transplantation has already been presented [ 10 ].…”