Inflammation Cancer Angiogenesis Biology and Therapeutics | Impact 0.1 (CiteScore) | Online ISSN  2207-872X
RESEARCH ARTICLE   (Open Access)

Value of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndrome for Predicting In-Hospital Complications and Mortality

Amanj Abubakr jalal Khaznadar 1*, Omed Hama Karem 1

+ Author Affiliations

Journal of Angiotherapy 8 (7) 1-11 https://doi.org/10.25163/angiotherapy.879724

Submitted: 18 May 2024 Revised: 20 July 2024  Published: 25 July 2024 


Abstract

Background: Acute coronary syndrome (ACS) refers to a spectrum of urgent heart conditions caused by a sudden decrease in blood flow to the heart. This condition demands immediate medical attention as it can lead to severe complications, including heart attack and death. The platelet-to-lymphocyte ratio (PLR) has recently gained attention as a potential biomarker for assessing the inflammatory status in ACS patients. Inflammation plays a crucial role in the pathophysiology of ACS, and biomarkers like PLR can offer insights into the severity and prognosis of the disease. Methods: This study was a prospective cross-sectional analysis conducted in Sulaymaniyah city, spanning from December 2021 to December 2022. The study included 100 patients who were diagnosed with ACS and subsequently hospitalized. Data collection involved comprehensive clinical histories, physical examinations, and laboratory analyses. Among the laboratory tests, complete blood counts were performed to calculate the PLR for each patient. Based on their PLR levels, patients were categorized into two primary groups for comparative analysis. Results: In a study of 100 ACS patients (mean age 61.54 years, 69% male), elevated PLR correlated with lower oxygen saturation, more frequent STE-ACS (70.6%), and higher in-hospital complications, including mortality (11.8%). No significant links were found between PLR and traditional CAD risk factors. Conclusion: The findings of this study underscore the potential prognostic value of PLR in ACS patients. Elevated PLR was significantly associated with worse oxygen saturation, a higher prevalence of STE-ACS, and an increased occurrence of in-hospital complications and mortality.

Keywords: Platelet-to-Lymphocyte Ratio (PLR), Acute Coronary Syndrome (ACS), In-hospital Mortality, Oxygen Saturation, Cardiovascular Complications

References


Abir, H., Azza, S., Sana Cheikh, R., Safa Ben, K., Amir, T., Yassine, O., et al. (2018). Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with acute exacerbation of chronic obstructive pulmonary disease. European Respiratory Journal, 52(62), PA1072. https://doi.org/10.1183/13993003.congress-2018.PA1072

Alomari, M., Bratton, H., Musmar, A., Al Momani, L. A., & Young, M. (2019). Ticagrelor-induced diarrhea in a patient with acute coronary syndrome requiring percutaneous coronary artery intervention. Cureus, 11(1), e3874. https://doi.org/10.7759/cureus.3874

Asoglu, R., Afsin, A., Asoglu, E., & Suner, A. (2019). Association between platelet/lymphocyte ratio and angiographic no-reflow in patients with non-ST-segment elevation acute myocardial infarction undergoing primary coronary intervention. International Journal of Clinical Cardiology, 6(1), 159. https://doi.org/10.23937/2378-2951/1410159

Babes, E. E., Bustea, C., Behl, T., Abdel-Daim, M. M., Nechifor, A. C., & Stoicescu, M., et al. (2022). Acute coronary syndromes in diabetic patients: Outcome, revascularization, and antithrombotic therapy. Biomedicine & Pharmacotherapy, 148, 112772. https://doi.org/10.1016/j.biopha.2022.112772

Balakumaran, V., Namrata, H., & Anirudhya, N. R. (2020). Analysis of complications of acute coronary syndrome and their outcomes in India. International Journal of Clinical Cardiology, 7(4), 1-8. https://doi.org/10.23937/2378-2951/1410194

Beverly, J. K., & Budoff, M. J. (2020). Atherosclerosis: Pathophysiology of insulin resistance, hyperglycemia, hyperlipidemia, and inflammation. Journal of Diabetes, 12(2), 102-104. https://doi.org/10.1111/1753-0407.12970

Beyhan Sagmen, S., & Kiral, N. (2020). The evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in asthma control. Revue Française d'Allergologie, 60(1), 20-23. https://doi.org/10.1016/j.reval.2019.09.001

Byrne, R. A., Rossello, X., Coughlan, J. J., Barbato, E., Berry, C., & Chieffo, A., et al. (2024). 2023 ESC guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal Acute Cardiovascular Care, 13(1), 55-161. https://doi.org/10.1093/ehjacc/zuad107

Demir, M., Duyuler, P. T., Guray, U., & Celik, M. C. (2018). Platelet to lymphocyte ratio on admission and prognosis in patients with acute cardiogenic pulmonary edema. The Journal of Emergency Medicine, 55(4), 465-471. https://doi.org/10.1016/j.jemermed.2018.06.021

Duan, J. G., Chen, X. Y., Wang, L., Lau, A., Wong, A., & Thomas, G. N., et al. (2015). Sex differences in epidemiology and risk factors of acute coronary syndrome in Chinese patients with type 2 diabetes: A long-term prospective cohort study. PLOS One, 10(4), e0122031. https://doi.org/10.1371/journal.pone.0122031

El Rabat, K., El-Nagar, A., & Ebaid, H. (2020). Significance of neutrophil/lymphocyte ratio with coronary artery calcium score detected by multislice computed tomography as a predictive marker of ischemia in type 2 diabetes mellitus patient. Benha Journal of Applied Sciences, 5(4), 5-9.

Estrada, E. A. C., Sequeda, E. R. M., Barros, J. E. B., Ríos, J. A. C., Segura, I. M. R., & Barreto, G. L. L. (2024). Acute coronary syndrome: Definition, pathophysiology, diagnosis, and management. World Journal of Advanced Research and Reviews, 21(1), 2537–2548. https://doi.org/10.30574/wjarr.2024.21.1.0352

Frak, W., Wojtasinska, A., Lisinska, W., Mlynarska, E., Franczyk, B., & Rysz, J. (2022). Pathophysiology of cardiovascular diseases: New insights into molecular mechanisms of atherosclerosis, arterial hypertension, and coronary artery disease. Biomedicines, 10(8). https://doi.org/10.3390/biomedicines10081938

Gherasie, F. A., Popescu, M. R., & Bartos, D. (2023). Acute coronary syndrome: Disparities of pathophysiology and mortality with and without peripheral artery disease. Journal of Personalized Medicine, 13(6), 944-963. https://doi.org/10.3390/jpm13060944

Hamid, M. B. (2016). Clinical characteristics and outcomes of acute coronary syndromes in a group of Iraqi patients. Iraqi Journal of Medical Sciences, 14(4), 304-311. https://doi.org/10.22578/IJMS.14.4.3

Heidarpour, M., Bashiri, S., Vakhshoori, M., Heshmat-Ghahdarijani, K., Khanizadeh, F., & Ferdowsian, S., et al. (2021). The association between platelet-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure. BMC Cardiovascular Disorders, 21(1), 454. https://doi.org/10.1186/s12872-021-02260-7

Hindieh, W., Pilote, L., Cheema, A., Al-Lawati, H., Labos, C., & Dufresne, L., et al. (2016). Association between family history, a genetic risk score, and severity of coronary artery disease in patients with premature acute coronary syndromes. Arteriosclerosis, Thrombosis, and Vascular Biology, 36(6), 1286-1292. https://doi.org/10.1161/ATVBAHA.115.306944

Intan, R. E., Alkaff, F. F., Oktaviono, Y. H., Nugraha, R. A., Octora, T. N., & Jonatan, M., et al. (2022). Retrospective study of the association between platelet-to-lymphocyte ratio in patients with acute coronary syndrome on admission to a rural referral center in East Java, Indonesia, and the incidence of new symptomatic heart failure at 6 months. Medical Science Monitor, 28, e935002. https://doi.org/10.12659/MSM.935002

Kazem, N., Hofer, F., Koller, L., Hammer, A., Hofbauer, T. M., & Hengstenberg, C., et al. (2022). The age-specific prognostic impact of the platelet-to-lymphocyte ratio on long-term outcome after acute coronary syndrome. European Heart Journal Open, 2(1), oeab031. https://doi.org/10.1093/ehjopen/oeab031

King-Shier, K., Quan, H., Kapral, M. K., Tsuyuki, R., An, L., & Banerjee, S., et al. (2019). Acute coronary syndromes presentations and care outcomes in white, South Asian, and Chinese patients: A cohort study. BMJ Open, 9(3), e022479. https://doi.org/10.1136/bmjopen-2018-022479

Kumar, H., Jilanee, D., Mehta, S. M., Gul, A., Shah, S. M. H., & Saleem, S., et al. (2022). Retraction: Frequency and predictors of acute kidney injury in patients with acute coronary syndrome in a tertiary care hospital: A retrospective study. Cureus, 14(3), r50. https://doi.org/10.7759/cureus.r50

Li, W., & He, C. (2022). Association of platelet-to-lymphocyte ratio with stroke-associated pneumonia in acute ischemic stroke. Journal of Healthcare Engineering, 2022(1), 1033332. https://doi.org/10.1155/2022/1033332

Menezes Fernandes, R., Mota, T., Costa, H., Bispo, J., Azevedo, P., Bento, D., et al. (2022). Premature acute coronary syndrome: Understanding the early onset. Coronary Artery Disease, 33(6), 456-464. https://doi.org/10.1097/mca.0000000000001141

Moazenzadeh, M., Hedayati, M., & Rashidinejad, H. (2023). Gender and age-based differences in risk factors and symptoms of acute coronary syndrome in a sample of Iranian patients. Journal of Kerman University of Medical Sciences, 30(2), 64-71. https://doi.org/10.34172/jkmu.2023.11

Niu, S., Pei, Y., Hu, X., Ding, D., & Jiang, G. (2022). Relationship between the neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio and deep venous thrombosis (DVT) following femoral neck fractures in the elderly. Frontiers in Surgery, 9, 1001432. https://doi.org/10.3389/fsurg.2022.1001432

Oylumlu, M., Oylumlu, M., Arslan, B., Polat, N., Özbek, M., Demir, M., et al. (2020). Platelet-to-lymphocyte ratio is a predictor of long-term mortality in patients with acute coronary syndrome. Postepy w Kardiologii Interwencyjnej = Advances in Interventional Cardiology, 16(2), 170-176. https://doi.org/10.5114/aic.2020.95859

Oylumlu, M., Yildiz, A., Oylumlu, M., Yüksel, M., Polat, N., Bilik, M. Z., et al. (2015). Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality in patients with acute coronary syndrome. Anatolian Journal of Cardiology, 15(4), 277-283. https://doi.org/10.5152/akd.2014.5366

Rafael, E., Sequeda, M., Cabrera Estrada, E. A., Sequeda, R. M., Barros, E. J., Enrique, J., et al. (2024). Acute coronary syndrome: Definition, pathophysiology, diagnosis, and management. World Journal of Advanced Research and Reviews, 21(3), 2537–2548. https://doi.org/10.30574/wjarr.2024.21.1.0352

Salehi, F. (2023). Modeling of SO2 gas pollutant emission of Arak Refinery using AERMOD model. Sustainability and Biodiversity Conservation, 2(1), 20–28. https://doi.org/10.5281/zenodo.7643232

Sharif, S., Maqbool, R., & Naz, S. (2022). Role of endothelin in hypertension: A review. Scientific Reports in Life Sciences, 3(4), 68–83. https://doi.org/10.5281/zenodo.7487458

Singh, A., Museedi, A. S., & Grossman, S. A. (2024). Acute coronary syndrome. In StatPearls. StatPearls Publishing. https://doi.org/10.3936/2024

Sönmez, O., Ertas, G., Bacaksiz, A., Tasal, A., Erdogan, E., Asoglu, E., et al. (2013). Relation of neutrophil-to-lymphocyte ratio with the presence and complexity of coronary artery disease: An observational study. Anadolu Kardiyoloji Dergisi: AKD = The Anatolian Journal of Cardiology, 13(7), 662-667. https://doi.org/10.5152/akd.2013.188

Subramanyam, P., & Saleem, A. (2024). Prospective study on clinical presentations of acute coronary syndrome at a tertiary care hospital in South India. International Journal of Medicine and Public Health, 14(1), 171-175. https://doi.org/10.5530/ijmedph.2024.1.34

Theofilis, P., Oikonomou, E., Chasikidis, C., Tsioufis, K., & Tousoulis, D. (2023). Pathophysiology of acute coronary syndromes—Diagnostic and treatment considerations. Life, 13(7), 1543. https://doi.org/10.3390/life13071543

Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., et al. (2018). Fourth universal definition of myocardial infarction. European Heart Journal, 40(3), 237-269. https://doi.org/10.1093/eurheartj/ehy462

Timmis, A., Kazakiewicz, D., Townsend, N., Huculeci, R., Aboyans, V., & Vardas, P. (2023). Global epidemiology of acute coronary syndromes. Nature Reviews Cardiology, 20(11), 778-788. https://doi.org/10.1038/s41569-023-00884-0

Vakaliuk, I., & Alzghawi, I. (2021). The structural-functional peculiarities of the heart in patients with acute coronary syndrome. Archive of Clinical Medicine, 27(1), 25-27. https://doi.org/10.21802/acm.2021.1.3

Winkler, C., Funk, M., Schindler, D. M., Hemsey, J. Z., Lampert, R., & Drew, B. J. (2013). Arrhythmias in patients with acute coronary syndrome in the first 24 hours of hospitalization. Heart & Lung: The Journal of Critical Care, 42(6), 422-427. https://doi.org/10.1016/j.hrtlng.2013.07.010

Zein, A. F., Nasution, S. A., Purnamasari, D., & Mansjoer, A. (2015). The influence of hyperglycemia at admission on in-hospital arrhythmia in patients with acute coronary syndrome. Acta Medica Indonesiana, 47(4), 291-296.

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