Key result
A higher neutrophil-to-lymphocyte ratio was an independent predictor of poorly developed coronary collateral circulation in patients with stable multivessel coronary artery disease (OR 0.756).
Why the study?
Inflammatory cells may influence coronary collateral circulation, but the relationship between neutrophil to lymphocyte ratio and collateral development in multivessel coronary artery disease required evaluation.
Does a higher neutrophil-to-lymphocyte ratio predict poorly developed coronary collateral circulation in patients with stable multivessel coronary artery disease?
Cross-Sectional (n=151)
No
Does a higher neutrophil-to-lymphocyte ratio predict poorly developed coronary collateral circulation in patients with stable multivessel coronary artery disease?
Odds Ratio: 0.756 (95% CI 0.587–0.974)
p-value: p=0.031
A higher neutrophil-to-lymphocyte ratio (>1.99) is independently associated with poorly developed coronary collateral circulation in patients with stable multivessel coronary artery disease.
N/L ratio may identify poor collaterals in multivessel CAD; hypothesis-generating and requires prospective validation before clinical use.
Background: Coronary collateral circulation (CCC) is an adaptive response to chronic myocardial ischemia. Patients with coronary stenosis develop varying degrees of collateral. Levels of inflammatory cells were suggested as potential determinants of collateral development. Neutrophil to lymphocyte (N/L) ratio has been proposed as a prognostic marker to determine systemic inflammatory response and the development of CCC. Our aim was to determine the relationship between N/L ratio and development of CCC in patients with coronary artery disease (CAD) with multivessel disease.Method:A total of 151 patients with multivessel disease were included in this study. Coronary collateral grades were classified according to Rentrop collateral grades as either poorly developed CCC (Rentrop grade 0-1) or well developed CCC (Rentrop grades 2-3). Factors significant at the p≤0.25 in the bivariate models were put into multiple logistic regressions. The receiver–operating characteristic (ROC) analysis were performed to determine the cutoff value of NLR in predicting poor CCC.Result: Of the 151 CAD patients in this study, 76 patients had poorly developed CCC and 75 patients had well developed CCC. Poorly developed CCC had significantly higher N/L ratio than well developed CCC (2.25±1.189 vs. 3.03±1.527, p <0.001). Logistic regression analysis showed that N/L ratio (OR0.756; CI 95% 0.587 – 0.974, p 0.031) was independent predictor of poorly developed CCC. The ROC analysis provided a cut-off value of 1.99 (AUC 0.72, sensitivity 78.9%, specificity 52%) for N/L ratio to predict poorly developed CCC.Conclusion: Higher neutrophil to lymphocyte ratio was useful in predicting poor coronary collateral circulation in stable coronary heart disease with multivessel disease. Neutrophil to lymphocyte ratio >1.99 was independently associated with impairment in coronary collateralization. This value had a sensitivity of 78.9% and specificity of 52%.
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Siregar et al. (2020) conducted a cross-sectional in Stable coronary artery disease with multivessel disease (n=151). Neutrophil-to-Lymphocyte Ratio vs. Lower Neutrophil-to-Lymphocyte Ratio was evaluated on Poorly developed coronary collateral circulation (Rentrop grade 0-1) (OR 0.756, 95% CI 0.587-0.974, p=0.031). A higher neutrophil-to-lymphocyte ratio was an independent predictor of poorly developed coronary collateral circulation in patients with stable multivessel coronary artery disease (OR 0.756).
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