Predictive Value of Combination of Neutrophil–Lymphocyte Ratio and Platelet–Lymphocyte Ratio for Prognosis

In the article ‘‘Neutrophil-Lymphocyte Ratio and PlateletLymphocyte Ratio Combination Can Predict Prognosis in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention,’’ Cicek et al reported that the combination of platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) may be an independent predictor of mortality in patients undergoing primary percutaneous coronary intervention (pPCI). Inflammation plays a significant role in cardiovascular disease. Therefore, it seems appropriate to use the combination of NLR and PLR in patients undergoing pPCI. However, in the Cicek et al study, there are no data about patient group medications during hospitalization and follow-up which can affect mortality and major adverse cardiovascular events (MACEs). The authors mention this limitation. Optimal medical therapy significantly reduces mortality and MACE in patients with ST-segment elevation myocardial infarction (STEMI). According to guidelines, it is recommended to use statins, beta-blockers, long-term treatment with acetylsalicylic acid, dual antiplatelet therapy for at least 12 months, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, and aldosterone receptor antogonists (if left ventricle ejection fraction 40%) to reduce mortality and MACE in patients with STEMI. Less optimal medical therapy in the intermediateand high-risk patient groups may have influenced mortality and MACE. The combination of NLR and PLR may indicate inflammation and poor prognosis in patients undergoing pPCI. However, to define its exact role in mortality and MACE, all conventional medical treatments that are known to reduce mortality and MACE should be considered.