Early Valuable Risk Stratification with Hemoglobin Level and Neutrophil to Lymphocyte Ratio in Patients with Non-ST-Elevation Myocardial Infarction Having an Early Invasive Strategy
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Objective: The complete blood count is the most widely available laboratory data in the early in-hospital period after acute myocardial infarction. We assessed the clinical utility of the combined use of hemoglobin (Hb) level and neutrophil to lymphocyte ratio (N/L) for early risk stratification in patients with non-ST-elevation myocardial infarction (STEMI). Methods: We analyzed 6,157 consecutive patients with non-STEMI (65±12.4 years, male 69%) were included in the final analysis. Patients were categorized into 3 groups by using the median value of N/L (4.42) and the presence of anemia (Hb <13 mg/dL in men and <12 mg/dL in women): group I, low N/L & no anemia (n=3,170); group II, no group I or III (n=2,168); group III, high N/L & anemia (n=819). Results: There were significant differences on clinical outcomes during 180-day follow-up among 3 groups. The prognostic discriminatory capacity of the combined use of Hb level and N/L was also significant in high-risk subgroups, such as patients with a renal dysfunction, multivessel coronary disease, low ejection fraction, and even in those having higher mortality risk based on the thrombolysis in myocardial infarction risk score. In a multi-variate logistic regression, after adjusting for multiple covariates, group III had higher incidence of major adverse cardiac events at 180-day (hazard ratio, 2.4; 95% confidence interval, 1.5–4.0;p≤0.001) compared with group I. Conclusions: The combined use of Hb level and N/L provides valuable timely information for early risk stratification in patients with non-STEMI.
Abstract
Objective: The complete blood count is the most widely available laboratory data in the early in-hospital period after acute myocardial infarction. We assessed the clinical utility of the combined use of hemoglobin (Hb) level and neutrophil to lymphocyte ratio (N/L) for early risk stratification in patients with non-ST-elevation myocardial infarction (STEMI). Methods: We analyzed 6,157 consecutive patients with non-STEMI (65±12.4 years, male 69%) were included in the final analysis. Patients were categorized into 3 groups by using the median value of N/L (4.42) and the presence of anemia (Hb <13 mg/dL in men and <12 mg/dL in women): group I, low N/L & no anemia (n=3,170); group II, no group I or III (n=2,168); group III, high N/L & anemia (n=819). Results: There were significant differences on clinical outcomes during 180-day follow-up among 3 groups. The prognostic discriminatory capacity of the combined use of Hb level and N/L was also significant in high-risk subgroups, such as patients with a renal dysfunction, multivessel coronary disease, low ejection fraction, and even in those having higher mortality risk based on the thrombolysis in myocardial infarction risk score. In a multi-variate logistic regression, after adjusting for multiple covariates, group III had higher incidence of major adverse cardiac events at 180-day (hazard ratio, 2.4; 95% confidence interval, 1.5–4.0;p≤0.001) compared with group I. Conclusions: The combined use of Hb level and N/L provides valuable timely information for early risk stratification in patients with non-STEMI.
참고문헌 (28)
- Maseri A, "Need for a composite risk stratification of patients with unstable coronary syndromes tailored to clinical practice", Circulation, 96, pp.4141~4142 (1997)
- Amsterdam EA, "2014 AHA", ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology, Circulation, pp.2014, 130[DOI]
- Becker RC, "Early assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcomes: a nationwide perspective of current clinical practice", Am Heart J, 135, pp.786~796 (1998)[DOI]
- Horne BD, "Which white blood cell subtypes predict increased cardiovascular risk?", J Am Coll Cardiol, 45, pp.1638~1643 (2005)[DOI]
- Nunez J, "Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction", Am J Cardiol, 101, pp.747~752 (2008)[DOI]
- Lee PC, "Anemia is an independent predictor of mortality after percutaneous coronary intervention", J Am Coll Cardiol, 44, pp.541~546 (2004)[DOI]
- Nikolsky E, "Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial", J Am Coll Cardiol, 44, pp.547~553 (2004)[DOI]
- Cho KH, "Value of early risk stratification using hemoglobin level and neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention", Am J Cardiol, 107, pp.849~856 (2011)[DOI]
- Nutritional anaemias, "Report of a WHO scientific group", World Health Organ Tech Rep Ser, 405, pp.5~37 (1968)
- Gibson CM, "Coronary and myocardial angiography: angiographic assessment of both epicardial and myocardial perfusion", Circulation, 109, pp.3096~3105 (2004)[DOI]
- Eagle KA, "A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry", JAMA, 291, pp.2727~2733 (2004)[DOI]
- Antman EM, "The TIMI risk score for unstable angina", non-ST elevation MI: a method for prognostication and therapeutic decision making, 2000, pp.284, 835~842
- Wu WC, "Blood transfusion in elderly patients with acute myocardial infarction", N Engl J Med, 345, pp.1230~1236 (2001)[DOI]
- Al Falluji N, "Effect of anemia on 1-year mortality in patients with acute myocardial infarction", Am Heart J, 144, pp.636~641 (2002)[DOI]
- Anderson RD, "Predicting outcome after thrombolysis in acute myocardial infarction according to ST-segment resolution at 90 minutes: a substudy of the GUSTO-III trial", Am Heart J, 144, pp.81~88 (2002)[DOI]
- Best PJ, "The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions", J Am Coll Cardiol, 39, pp.1113~1119 (2002)[DOI]
- Gottlieb SS, "Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction", N Engl J Med, 339, pp.489~497 (1998)[DOI]
- Wahr JA, "Myocardial ischaemia in anaemic patients", Br J Anaesth, 81(Suppl 1), pp.10~15 (1998)
- Most AS, "Effect of a reduction in blood viscosity on maximal myocardial oxygen delivery distal to a moderate coronary stenosis", Circulation, 74, pp.1085~1092 (1986)[DOI]
- Kaiafa G, "Is anemia a new cardiovascular risk factor?", Int J Cardiol, 186, pp.117~124 (2015)[DOI]
- Yoshikawa H, "Effect of acute anemia on experimental myocardial ischemia", Am J Cardiol, 32, pp.670~678 (1973)[DOI]
- Hoffman M, "Leukocytes and coronary heart disease", Atherosclerosis, 172, pp.1~6 (2004)[DOI]
- Barron HV, "Association between white blood cell count, epicardial blood flow, myocardial perfusion, and clinical outcomes in the setting of acute myocardial infarction: a thrombolysis in myocardial infarction 10 substudy", Circulation, 102, pp.2329~2334 (2000)[DOI]
- Duffy BK, "Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention", Am J Cardiol, 97, pp.993~996 (2006)[DOI]
- Ricevuti G, "New trends in coronary artery disease: the role of granulocyte activation", Atherosclerosis, 78, pp.261~265 (1989)[DOI]
- Madjid M, "Leukocyte count and coronary heart disease: implications for risk assessment", J Am Coll Cardiol, 44, pp.1945~1956 (2004)[DOI]
- Onsrud M, "Influence of in vivo hydrocortisone on some human blood lymphocyte subpopulations. I. Effect on natural killer cell activity", Scand J Immunol, 13, pp.573~579 (1981)[DOI]
- Thomson SP, "Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction", Ann Intern Med, 122, pp.335~341 (1995)[DOI]