Original ArticleClinicalNeutrophil to Lymphocyte Ratio Is Related to Electrocardiographic Sign of Spontaneous Reperfusion in Patients with ST-segment Elevation Myocardial Infarction
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)
- et al.
Relation of clinically defined spontaneous reperfusion to outcome in ST-elevation myocardial infarction
Am J Cardiol
(2009) - et al.
Spontaneous reperfusion in ST-elevation myocardial infarction: comparison of angiographic and electrocardiographic assessments
Am Heart J
(2008) - et al.
Neutrophil to lymphocyte ratio in acute ST-segment elevation myocardial infarction
Am J Med Sci
(2014) - et al.
Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention
Clinics (Sao Paulo)
(2015) - et al.
Extent of early ST segment elevation resolution: a simple but strong predictor of outcome in patients with acute myocardial infarction
J Am Coll Cardiol
(1994) - et al.
ST segment resolution as a tool for assessing the efficacy of reperfusion therapy
J Am Coll Cardiol
(2001) - et al.
The histopathologic evolution of myocardial infarction
Chest
(1978) - et al.
Leukocyte count and coronary heart disease: implications for risk assessment
J Am Coll Cardiol
(2004) - et al.
Association of leukocyte and neutrophil counts with infarct size, left ventricular function and outcomes after percutaneous coronary intervention for ST-elevation myocardial infarction
Am J Cardiol
(2009) - et al.
Post-reperfusion lymphopenia and microvascular obstruction in ST-segment elevation acute myocardial infarction
Rev Esp Cardiol
(2009)