Key result
In very old patients with acute myocardial infarction, an elevated neutrophils-plus-monocytes-to-lymphocytes ratio (NMLR) was a significant independent predictor of cardiovascular mortality (HR 3.21).
Why the study?
Data regarding the prognostic utility of total and differential leukocyte counts in very old patients with acute myocardial infarction were lacking.
Do elevated neutrophil-plus-monocyte-to-lymphocyte ratio (NMLR) and neutrophil-to-lymphocyte ratio (NLR) predict cardiovascular mortality in very old patients (≥80 years) with acute myocardial infarction?
Cohort (n=523)
No
Do elevated neutrophil-plus-monocyte-to-lymphocyte ratio (NMLR) and neutrophil-to-lymphocyte ratio (NLR) predict cardiovascular mortality in very old patients (≥80 years) with acute myocardial infarction?
In very old patients (≥80 years) with acute myocardial infarction, elevated NMLR and NLR are strong, independent predictors of cardiovascular mortality, improving risk stratification beyond traditional models.
Leukocyte ratios may refine mortality prediction in very old AMI patients; extends prior CAD data but leaves clinical adoption open.
BACKGROUND: Total leukocyte and differential Leukocyte counts are prognostic indictors in patients with coronary artery disease (CAD). However, there is no data available regarding their prognostic utility in very old patients with acute myocardial infarction (AMI). The aim of this study is to investigate the potential role of different leukocyte parameters in predicting the mortality among very old patients with AMI. METHODS: A total of 523 patients aged over 80 years with AMI were consecutively enrolled into this study. Leukocyte and its subtypes were obtained at admission in each patient. The primary study endpoint was cardiovascular mortality. Patients were followed up for an average of 2.2 years and 153 patients died. The associations of leukocyte parameters with mortality were assessed using Cox regression analyses. The concordance index was calculated to test the model efficiency. RESULTS: In multivariable regression analysis, neutrophils-plus-monocytes-to-lymphocytes ratio (NMLR) and neutrophils-to-lymphocytes ratio (NLR) were two most significant predictors of mortality among all the leukocyte parameters (HR = 3.21, 95% CI 1.75-5.35; HR = 2.79, 95% CI 1.59-4.88, respectively, all p < 0.001, adjusted for age, male gender, body mass index, family history of CAD, smoking, hypertension, diabetes mellitus, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, high sensitivity C-reactive protein, creatinine, left ventricular ejection fraction, troponin I, use of statin, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and percutaneous coronary intervention). Furthermore, adding NMLR and NLR into the Cox model increased the C-statistic by 0.038 and 0.037 respectively, which were more significant than that of other leukocyte parameters. Besides, addition of NMLR and NLR to the Canada Acute Coronary Syndrome Risk Score model also increased the C-statistic by 0.079 and 0.077 respectively. CONCLUSION: Our data firstly indicated that most leukocyte subtypes were independent markers for the mortality in very old patients with AMI, while NMLR and NLR appeared to be more effective.
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Jin et al. (2020) conducted a cohort in Acute myocardial infarction (n=523). Neutrophils-plus-monocytes-to-lymphocytes ratio (NMLR) vs. Lower tertile of NMLR was evaluated on Cardiovascular mortality (HR 3.21, 95% CI 1.75-5.35, p=<0.001). In very old patients with acute myocardial infarction, an elevated neutrophils-plus-monocytes-to-lymphocytes ratio (NMLR) was a significant independent predictor of cardiovascular mortality (HR 3.21).
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