What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease (n=199). Intervention: Lymphocyte to monocyte ratio. Primary outcome: Severe coronary atherosclerosis (Gensini score ≥40) (OR 0.715, 95% CI 0.551-0.927, p=0.012).

October 1, 2018Open Access

Association of lymphocyte to monocyte ratio with severity of coronary artery disease

Key Result

A lower lymphocyte to monocyte ratio was an independent predictor of severe coronary atherosclerosis (OR 0.715) and was associated with a higher rate of cardiovascular events at 1 year.

Study Design

Type

Observational (n=199)

Multicenter

Structured PICO

Does the lymphocyte to monocyte ratio predict the severity of coronary artery disease and future cardiovascular events in patients undergoing coronary angiography?

Population

199 consecutive patients with known or suspected coronary artery disease (CAD) undergoing diagnostic coronary angiography at a single center in China. Exclusions included recent acute coronary syndrome, history of previous coronary intervention or CABG, severe valvular heart disease, decompensated heart failure, cerebrovascular disease, renal or hepatic disease, acute or chronic infection/inflammation, malignancy, malnutrition, hematologic disease, symptomatic peripheral arterial disease, autoimmune disease, pregnancy, and chronic obstructive lung disease.

Intervention

Lymphocyte to monocyte ratio (LMR) measurement (observational exposure)

Comparator

Normal coronary arteries (control) vs mild atherosclerosis (Gensini score 1-40) vs severe atherosclerosis (Gensini score ≥40); and LMR > 5.06 vs LMR ≤ 5.06

Outcome

Severity of coronary artery disease assessed by Gensini scoresurrogate

A lower lymphocyte to monocyte ratio is independently associated with more severe coronary atherosclerosis and predicts a higher risk of future cardiovascular events in patients with coronary artery disease.

Main Result

Effect estimate: OR 0.715 (95% CI 0.551-0.927)

p-value: p=0.012

Limitations

Assessment of CAD severity by coronary angiography rather than more sensitive methods like IVUS or CT
Small study population
Other inflammatory cytokines like TNF-alpha and CRP were not measured

Abstract

The aim of this study was to investigate the relationship between lymphocyte to monocyte ratio (LMR) and the severity of coronary artery disease (CAD) by using Gensini score.A total of 199 patients, who had undergone coronary angiography, were included in the study and retrospectively analyzed. Among them, 49 patients who had normal coronary arteries were selected as the control group. Patients with CAD were divided into 2 groups, those with low Gensini score (≤40) and those with high Gensini score (≥40).Our results showed that LMR in the severe atherosclerosis group was significantly lower than those of the mild atherosclerosis group and the control group. There was a closely significant correlation between the Gensini score and LMR (r = -0.362, P < .001). Furthermore, multivariate logistic regression analysis demonstrated that LMR (odds ratio, 0.715; 95% confidence interval CI, 0.551-0.927; P = .012) was independent predictors of severe atherosclerosis. Using an optimal LMR cut-off value of 5.06, LMR predicted severe atherosclerosis with a sensitivity of 57.1% and specificity of 69.7% (area under curve = 0.634; 95% CI, 0.545-0.724; P = .005). Then patients with CAD group was divided into 2 groups according to the LMR value of 5.06. Patients with LMR ≤ 5.06 had worse prognosis, with a higher rate of cardiovascular events during up to 1 year follow-up.Our study demonstrated that LMR was independently and positively associated with the severity of coronary atherosclerosis, providing a new insight in the application of inflammation index evaluating the severity of CAD. And LMR may be a useful predictor of future cardiovascular events in patients with CAD.

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