Original Article
Clinical
Neutrophil to Lymphocyte Ratio Is Related to Electrocardiographic Sign of Spontaneous Reperfusion in Patients with ST-segment Elevation Myocardial Infarction

https://doi.org/10.1016/j.arcmed.2016.06.002Get rights and content

Background and Aims

ST-segment resolution ≥70% on consecutive electrocardiograms (ECGs) before administration of definitive reperfusion therapy is considered as an electrocardiographic sign of spontaneous reperfusion (SR) in STEMI patients and it indicates not only the patency of the infarct-related artery (IRA) but also the microvascular and myocardial reperfusion. Neutrophil/lymphocyte (N/L) ratio has been demonstrated to be associated with the patency of the IRA and no-reflow in patients with STEMI before mechanical reperfusion therapy. However, the association between N/L ratio and ST-segment resolution in STEMI patients with SR was not investigated. The aim of this study was to focus on the relation between N/L ratio and ST-segment resolution in STEMI patients with SR.

Methods

One hundred sixty two consecutive patients with their first diagnosed STEMI were enrolled in this study. ECGs of all the patients at admission and 1 h later were obtained. According to electrocardiographic sign of SR, the patients were divided into two groups as SR group and non-SR group. Clinical data between two groups were evaluated.

Results

Patients in SR group had lower neutrophil counts, higher lymphocyte counts, and lower N/L ratio than patients in non-SR group. Moreover, after undertaking primary PCI, patients in SR group had lower peak cTnT value and higher LVEF than patients in non-SR group. Furthermore, N/L ratio was an independent predictor of electrocardiographic sign of SR in patients with STEMI.

Conclusion

N/L ratio, an easily available laboratory data, may be related to microvascular reperfusion in STEMI patients with electrocardiographic sign of SR.

Introduction

Immediate and successful restoration of normal blood flow in infarct-related artery (IRA) has been demonstrated to be the most effective therapy for patients with acute ST-segment elevation myocardial infarction (STEMI) (1). However, spontaneous reperfusion (SR) of the IRA may occur in 18–29% of patients with STEMI (2). Several studies have shown in patients with STEMI undergoing primary percutaneous coronary intervention (PCI) that the presence of SR is associated with smaller infarction, higher procedural success, and more favorable short- and long-term prognosis 2, 3.

ST-segment resolution ≥70% on consecutive electrocardiograms (ECGs) before administration of definitive reperfusion therapy is defined as an electrocardiographic sign of SR in STEMI patients 2, 4. Previous studies have shown that ST-segment resolution ≥70% in STEMI patients receiving thrombolytic therapy indicated not only the patency of the IRA but also the microvascular and myocardial reperfusion (5). Additionally, it has been known that the absence of microvascular reperfusion is one of the reasons linked to no-reflow phenomenon in STEMI patients undergoing reperfusion therapy. More recently, neutrophil to lymphocyte (N/L) ratio, a novel inflammatory marker, has been demonstrated to be associated with the patency of the IRA and no-reflow in patients with STEMI before mechanical reperfusion therapy 6, 7, 8. However, the association between N/L ratio and ST-segment resolution in STEMI patients with SR was not investigated. The aim of this study was to focus on the relation between N/L ratio and ST-segment resolution in STEMI patients with SR.

Section snippets

Study Patients

One hundred sixty two consecutive patients (mean age 66.2 ± 5.2 years) with their first acute STEMI within 6 h from the onset of symptoms undergoing primary PCI at our hospital between March 2014 and May 2015 were enrolled in this study. STEMI was diagnosed according to typical chest pain lasting for at least 30 min and cumulative ST-segment elevation was at least 1 mm in at least two contiguous ECG leads (2 mm for leads V1–V3).

Patients complicated with cardiac shock or patients whose ECGs

Results

Based on electrocardiographic sign of SR, 162 patients were divided into two groups as SR group and non-SR group. Baseline clinical characteristics of the patients in two groups are summarized in Table 1. No differences were observed between groups in age, sex, major risk factors, and medical history. Similarly, no differences were noted between groups in the median time intervals from symptom onset to the acquisition of the 60-min ECG and the median time intervals from symptom onset to primary

Discussion

The main findings in the present study are (1) STEMI patients with electrocardiographic sign of SR (SR group) had lower neutrophil counts, higher lymphocyte counts, and lower N/L ratio than patients without electrocardiographic sign of SR (non-SR group), (2) after undergoing primary PCI, patients in SR group had lower peak cTnT value and higher LVEF than patients in non-SR group, and (3) N/L ratio was an independent predictor of electrocardiographic sign of SR in patients with STEMI.

ST-segment

Conflict of Interest

The authors declare that they have no conflict of interest.

References (27)

  • P.T. O'Gara et al.

    American College of Cardiology Foundation/American Heart Association Task ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

    Circulation

    (2013)
  • K. Iwakura et al.

    Detection of TIMI-3 flow before mechanical reperfusion with ultrasonic tissue characterization in patients with anterior wall acute myocardial infarction

    Circulation

    (2003)
  • R. Schroder

    Prognostic impact of early ST-segment resolution in acute ST-elevation myocardial infarction

    Circulation

    (2004)
  • Cited by (0)

    View full text