November 30, 2016Open Access

Prognostic Value of Eosinophil to Leukocyte Ratio in Patients with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ST-Elevation Myocardial Infarction (n=331). Intervention: Eosinophil to leukocyte ratio (ELR). Primary outcome: Major adverse cardiac events (MACEs) (OR 0.38, 95% CI 0.22-0.67, p=<0.001).

Key Result

An eosinophil to leukocyte ratio <0.1 at 24 hours independently predicted major adverse cardiac events at one year in STEMI patients undergoing primary PCI (OR 0.38; 95% CI 0.22-0.67; p<0.001).

Study Design

Type

Cohort (n=331)

Structured PICO

Does an eosinophil to leukocyte ratio < 0.1 at 24 hours predict major adverse cardiac events in patients with STEMI undergoing primary PCI?

Population

331 consecutive patients who underwent primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) between January 2009 and March 2015. Exclusions included infections, allergic diseases, malignancies, presentation >48 h after onset, or death within 24 h after admission.

Intervention

Eosinophil to leukocyte ratio (ELR) < 0.1 at 24 hours after hospital admission

Comparator

Eosinophil to leukocyte ratio (ELR) ≥ 0.1 at 24 hours after hospital admission

Outcome

Major adverse cardiac events (MACEs) at one year, defined as a composite of death, Q-wave MI, and the need for target lesion revascularization (TLR) or target vessel revascularization (TVR) by coronary artery bypass graft or repeat PCIcomposite

In patients with STEMI undergoing primary PCI, an eosinophil to leukocyte ratio < 0.1 at 24 hours is an independent predictor of major adverse cardiac events at one year.

Main Result

Effect estimate: OR 0.38 (95% CI 0.22-0.67)

p-value: p=<0.001

Abstract

AIM: Leukocyte profile has been related to clinical outcome in patients with ST-segment elevation (STE) myocardial infarction (MI). However, whether eosinophil to leukocyte ratio (ELR) predicts clinical outcome in patients who have undergone primary percutaneous coronary intervention (PCI) remains unclear. Therefore, we examined the prognostic value of ELR in this patient population. METHODS: We retrospectively analyzed the data of 331 consecutive patients who underwent primary PCI for STEMI between January 2009 and March 2015. All leukocyte types were counted and ELR was calculated for all patients 24 h after hospital admission. The primary study endpoint was major adverse cardiac events (MACEs) within up to one year of follow-up duration. RESULTS: MACEs including cardiac deaths in 9.4% of the patients, MI in 1.5%, and target lesion or vessel revascularization in 10.3%, occurred within one year in 68 patients (20.5%). The mean ELR was significantly lower in patients with MACEs than in patients without MACEs (0.20±0.51 vs.0.49±0.66, respectively; p＜0.001). An ELR ＜0.1 at 24 h was identified as the best cut-off value for mortality prediction. Multivariate analysis identified that an ELR ＜0.1 (odds ratio OR=0.38; 95% confidence interval CI=0.22-0.67; p＜0.001) and chronic kidney disease (OR=2.38; CI=1.33-4.24; p=0.003) are independent predictors of MACEs. CONCLUSION: In primary PCI patients with STEMI, ELR at 24 h was an independent predictor of MACEs in addition to the usual coronary risk factors and commonly used biomarkers.

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