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January 1, 2025Revista română de medicină de laboratorOpen Access

In multivariable analysis, adding NLR >2.99 (HR=4.58, p<0.001) and MLR >0.36 (HR=4.74, p<0.001) to age and heart failure significantly increased the predictive power for all-cause mortality (chi-square increased from 33.00 to 51.08, p<0.001).

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Why the study?

Systemic inflammation is a key pathophysiological mechanism in INOCA, but the value of NLR, MLR, and PLR as predictors of long-term all-cause mortality remained to be evaluated.

Do elevated neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio predict long-term all-cause mortality in patients with ischemia and non-obstructive coronary arteries?

Population

238 acute or chronic INOCA patients

Comparison

NLR, MLR, and PLR levels

Design

Retrospective observational study

Follow-up

Mean 5.8±1.1 years

Authors

EMEmilian Dumitru MihaiCDCaterina DelceaABA Buzea

Discussion

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Overview

May support NLR/MLR/PLR as INOCA prognostic markers; hypothesis-generating, needs prospective validation before clinical use.

Structured PICO

Do elevated neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio predict long-term all-cause mortality in patients with ischemia and non-obstructive coronary arteries?

P
Population
238 consecutive patients with acute or chronic ischemia with non-obstructive coronary arteries (INOCA) confirmed by invasive coronary angiography, mean age 64.1 years, 62.2% female, based in Romania. Excluded: pulmonary hypertension, acute non-cardiac pathology, and in-hospital mortality.
I
Intervention
Elevated neutrophil-to-lymphocyte ratio (NLR >2.99, 3rd tertile) and monocyte-to-lymphocyte ratio (MLR >0.36, 3rd tertile)
C
Comparator
Lower tertiles of neutrophil-to-lymphocyte ratio (NLR ≤2.99) and monocyte-to-lymphocyte ratio (MLR ≤0.36)
O
Outcome
All-cause mortality at mean 5.8 ± 1.1 years follow-uphard clinical

Elevated neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio are independent predictors of long-term all-cause mortality in patients with INOCA, improving risk stratification beyond traditional clinical factors.

Limitations

  • Retrospective design
  • Single center

Cite This Study

Mihai et al. (2025) studied this question.

synapsesocial.com/papers/6a73c0cb46cd4472af69ef55https://doi.org/10.2478/rrlm-2025-0004
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries2020 · 19 citations
  2. 2Prognostic potential of neutrophil-to-lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio in acute myocardial infarction patients combined with chronic obstructive pulmonary disease2024 · 9 citations
  3. 3Association between neutrophil-to-lymphocyte ratio and short-term all-cause mortality in patients with cerebrovascular disease admitted to the intensive care unit-a study based on the MIMIC-IV database2024 · 4 citations
  4. 4Association of inflammatory markers based on routine blood with prognosis in patients underwent percutaneous coronary intervention2024 · 5 citations
  5. 5Association of Neutrophil-to-Lymphocyte Ratio With Clinical Outcomes After Percutaneous Coronary Intervention2025 · 6 citations