Association of Neutrophil-to-Lymphocyte Ratio with Severity and Prognosis of Acute Coronary Syndrome
Keywords:
Acute Coronary Syndrome, Neutrophil-To-Lymphocyte Ratio, Inflammation, Coronary Artery Disease, Prognosis, Major Adverse Cardiovascular Events.Abstract
Background: Inflammation plays a critical role in the development and progression of atherosclerosis and acute coronary syndrome (ACS). The neutrophil-to-lymphocyte ratio (NLR), an easily available marker of systemic inflammation, has emerged as a potential predictor of coronary artery disease severity and adverse cardiovascular outcomes. This study aimed to evaluate the association of NLR with angiographic severity and prognosis among patients presenting with ACS.
Methods: This prospective observational cohort study included 150 patients with ACS. Baseline demographic characteristics, cardiovascular risk factors, clinical presentation, laboratory parameters, and NLR values were recorded at admission. Coronary angiographic findings were assessed to determine the extent of coronary artery disease. Patients were categorized into low NLR (<3.5) and high NLR (≥3.5) groups. The association of NLR with angiographic severity and in-hospital major adverse cardiovascular events (MACE) was analyzed. Multivariate logistic regression was performed to identify independent predictors of adverse outcomes.
Results: The mean age of patients was 58.6 ± 11.4 years, and 74.7% were males. The mean NLR value was 3.8 ± 1.9. Triple vessel disease was associated with significantly higher NLR values compared with single and double vessel disease (5.1 ± 2.0 vs 2.6 ± 1.1 and 3.7 ± 1.5; p<0.001). Patients with high NLR had increased prevalence of STEMI (59.7% vs 37.2%; p=0.006) and lower LVEF (43.2 ± 9.4% vs 50.1 ± 8.7%; p<0.001). High NLR was significantly associated with increased MACE (31.9% vs 10.3%; p<0.001), mortality (12.5% vs 2.6%; p=0.03), and heart failure (25.0% vs 7.7%; p=0.004). On multivariate analysis, high NLR independently predicted MACE (OR: 3.6; 95% CI: 1.8–7.2; p<0.001).
Conclusion: Elevated NLR is significantly associated with increased coronary disease severity and adverse in-hospital outcomes in patients with ACS. NLR may serve as a simple, cost-effective, and clinically useful biomarker for early risk stratification and prognostic assessment.
