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Cardiovascular & Hematological Disorders-Drug Targets

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ISSN (Print): 1871-529X
ISSN (Online): 2212-4063

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Research Article

Association of Novel Hematological Indices with Severity of Coronary Artery Disease using SYNTAX Score in Patients with Acute Coronary Syndrome

Author(s): Vivek Mohanty, Shubham Sharma, Sourabh Goswami, Atul Kaushik, Rahul Choudhary, Dharamveer Yadav, Surender Deora* and Kuldeep Singh

Volume 23, Issue 3, 2023

Published on: 10 November, 2023

Page: [202 - 211] Pages: 10

DOI: 10.2174/011871529X269740231102045028

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Abstract

Introduction: Recent evidence suggests that systemic inflammation not only plays an important role in the pathogenesis of Acute Coronary Syndrome but also correlates with disease severity. Monocyte-to-high-density lipoprotein cholesterol ratio (MHR), Neutrophil-Lymphocyte Ratio (NLR), and Monocyte-Lymphocyte Ratio (MLR) are novel systemic inflammation markers used for predicting the burden of coronary artery disease (CAD) based on SYNTAX Score. This single-center, cross-sectional, observational study compared the association of these novel hematological indices with CAD severity using the SYNTAX Score in ACS patients and aimed to determine the best predictor of the severity of CAD.

Methods: A total of 403 consecutive patients with ACS who underwent coronary angiography were enrolled. On the basis of the SYNTAX Score, patients were divided into three groups: Low: <22, Moderate 22 - 32 and High ≥ 32. MHR, MLR, and NLR were calculated and correlated with SYNTAX Score.

Results: All three indices: MHR (r=0.511; p <0.001), MLR (r=0.373; p <0.001), and NLR (r=0.292; p =0.001) showed significant correlation with SYNTAX Score. The MHR ROC was significantly higher than that of MLR (difference between area: 0.158; 95% CI: 0.079-0.259) and NLR (difference between area: 0.279; 95% CI: 0.172-0.419) for the SYNTAX Score. Analysis showed a strong correlation between these indices with SYNTAX Score >22 compared to low scores <22 and that these also related to the LAD as an infarct artery. Multiple regression analysis showed that diabetes mellitus, eGFR, Infarct-related artery left anterior descending (IRALAD), MHR, MLR, and NLR were predictors of the severity of CAD in ACS patients based on SYNTAX Score.

Conclusion: In ACS patients MHR, MLR, and NLR showed significant correlation with SYNTAX score >22 which may be indicative of severity of disease. MHR is a better predictor of the severity of CAD than MLR and NLR in ACS patients.

Keywords: Monocyte to high-density cholesterol ratio, neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, acute coronary syndrome, percutaneous coronary intervention, SYNTAX score.

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[1]
Nowbar, A.N.; Gitto, M.; Howard, J.P.; Francis, D.P.; Al-Lamee, R. Mortality from ischemic heart disease: Analysis of data from the World Health Organization and coronary artery disease risk factors From NCD risk factor collaboration. Circ. Cardiovasc. Qual. Outcomes, 2019, 12(6), e005375.
[http://dx.doi.org/10.1161/CIRCOUTCOMES.118.005375] [PMID: 31163980]
[2]
Libby, P.; Ridker, P.M.; Hansson, G.K. Inflammation in atherosclerosis. J. Am. Coll. Cardiol., 2009, 54(23), 2129-2138.
[http://dx.doi.org/10.1016/j.jacc.2009.09.009] [PMID: 19942084]
[3]
Ridker, P.M.; Danielson, E.; Fonseca, F.A.H.; Genest, J.; Gotto, A.M., Jr; Kastelein, J.J.P.; Koenig, W.; Libby, P.; Lorenzatti, A.J.; MacFadyen, J.G.; Nordestgaard, B.G.; Shepherd, J.; Willerson, J.T.; Glynn, R.J. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N. Engl. J. Med., 2008, 359(21), 2195-2207.
[http://dx.doi.org/10.1056/NEJMoa0807646] [PMID: 18997196]
[4]
Ridker, P.M.; Everett, B.M.; Thuren, T.; MacFadyen, J.G.; Chang, W.H.; Ballantyne, C.; Fonseca, F.; Nicolau, J.; Koenig, W.; Anker, S.D.; Kastelein, J.J.P.; Cornel, J.H.; Pais, P.; Pella, D.; Genest, J.; Cifkova, R.; Lorenzatti, A.; Forster, T.; Kobalava, Z.; Vida-Simiti, L.; Flather, M.; Shimokawa, H.; Ogawa, H.; Dellborg, M.; Rossi, P.R.F.; Troquay, R.P.T.; Libby, P.; Glynn, R.J. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N. Engl. J. Med., 2017, 377(12), 1119-1131.
[http://dx.doi.org/10.1056/NEJMoa1707914] [PMID: 28845751]
[5]
Gurm, H.S.; Bhatt, D.L.; Lincoff, A.M.; Tcheng, J.E.; Kereiakes, D.J.; Kleiman, N.S.; Jia, G.; Topol, E.J. Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials. Br. Heart J., 2003, 89(10), 1200-1204.
[http://dx.doi.org/10.1136/heart.89.10.1200] [PMID: 12975419]
[6]
Hansson, G.K. Inflammation, atherosclerosis, and coronary artery disease. N. Engl. J. Med., 2005, 352(16), 1685-1695.
[http://dx.doi.org/10.1056/NEJMra043430] [PMID: 15843671]
[7]
Newby, A.C. Metalloproteinase expression in monocytes and macrophages and its relationship to atherosclerotic plaque instability. Arterioscler. Thromb. Vasc. Biol., 2008, 28(12), 2108-2114.
[http://dx.doi.org/10.1161/ATVBAHA.108.173898] [PMID: 18772495]
[8]
Pamukcu, B.; Lip, G.Y.H.; Devitt, A.; Griffiths, H.; Shantsila, E. The role of monocytes in atherosclerotic coronary artery disease. Ann. Med., 2010, 42(6), 394-403.
[http://dx.doi.org/10.3109/07853890.2010.497767] [PMID: 20568979]
[9]
Eriksson, E.; Xie, X.; Werr, J.; Thoren, P.; Lindbom, L. Direct viewing of atherosclerosis in vivo: Plaque invasion by leukocytes is initiated by the endothelial selectins. FASEB J., 2001, 15(7), 1149-1157.
[http://dx.doi.org/10.1096/fj.00-0537com] [PMID: 11344083]
[10]
Junger, W.G.; Hoyt, D.B.; Davis, R.E.; Herdon-Remelius, C.; Namiki, S.; Junger, H.; Loomis, W.; Altman, A. Hypertonicity regulates the function of human neutrophils by modulating chemoattractant receptor signaling and activating mitogen-activated protein kinase p38. J. Clin. Invest., 1998, 101(12), 2768-2779.
[http://dx.doi.org/10.1172/JCI1354] [PMID: 9637711]
[11]
Rye, KA; Bursill, CA; Lambert, G; Tabet, F; Barter, PJ The metabolism and anti-atherogenic properties of HDL. J Lipid Res., 2009, 50 Suppl, S195-S200.
[12]
Ommen, S.R.; Gibbons, R.J.; Hodge, D.O.; Thomson, S.P. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am. J. Cardiol., 1997, 79(6), 812-814.
[http://dx.doi.org/10.1016/S0002-9149(96)00878-8] [PMID: 9070569]
[13]
Kundi, H.; Kiziltunc, E.; Cetin, M.; Cicekcioglu, H.; Cetin, Z.G.; Cicek, G.; Ornek, E. Association of monocyte/HDL-C ratio with SYNTAX scores in patients with stable coronary artery disease. Herz, 2016, 41(6), 523-529.
[http://dx.doi.org/10.1007/s00059-015-4393-1] [PMID: 26753671]
[14]
Yurtdaş M.; Yaylali, Y.T.; Kaya, Y.; Özdemir, M.; Özkan, İ, Aladağ N. Neutrophil-to-lymphocyte ratio may predict subclinical atherosclerosis in patients with psoriasis. Echocardiography, 2014, 31(9), 1095-1104.
[http://dx.doi.org/10.1111/echo.12511] [PMID: 24447343]
[15]
Kurtul, S.; Sarli, B.; Baktir, A.O.; Demirbas, M.; Saglam, H. Doğan, Y.; Sahin, O.; Akpek, M.; Odabas, H.; Arinc, H.; Kaya, M.G. Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with non-ST segment elevation myocardial infarction. Int. Heart J., 2015, 56(1), 18-21.
[http://dx.doi.org/10.1536/ihj.14-175] [PMID: 25742940]
[16]
Gu, L.F.; Gu, J.; Wang, S.B.; Wang, H.; Wang, Y.X.; Xue, Y.; Wei, T.W.; Sun, J.T.; Lian, X.Q.; Liu, J.B.; Jia, E.Z.; Wang, L.S. Combination of D-dimer level and neutrophil to lymphocyte ratio predicts long-term clinical outcomes in acute coronary syndrome after percutaneous coronary intervention. Cardiol. J., 2023, 30(4), 576-586.
[http://dx.doi.org/10.5603/CJ.a2021.0097] [PMID: 34490603]
[17]
Sianos, G.; Morel, M.A.; Kappetein, A.P.; Morice, M.C.; Colombo, A.; Dawkins, K.; van den Brand, M.; Van Dyck, N.; Russell, M.E.; Mohr, F.W.; Serruys, P.W. The SYNTAX Score: An angiographic tool grading the complexity of coronary artery disease. EuroIntervention, 2005, 1(2), 219-227.
[PMID: 19758907]
[18]
Capodanno, D.; Di Salvo, M.E.; Cincotta, G.; Miano, M.; Tamburino, C.; Tamburino, C. Usefulness of the SYNTAX score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease. Circ. Cardiovasc. Interv., 2009, 2(4), 302-308.
[http://dx.doi.org/10.1161/CIRCINTERVENTIONS.108.847137] [PMID: 20031732]
[19]
Karakayalı M.; Omar, T.; Artaç, I.; Rencüzoğulları I.; Karabağ Y.; Hamideyin, Ş.; Altunova, M. The white blood cell count to mean platelet volume ratio (WMR) is associated with syntax score in patients with ST-segment elevation myocardial infarction. Kafkas Journal of Medical Sciences, 2023, 13(2), 173-178.
[http://dx.doi.org/10.5505/kjms.2023.98512]
[20]
Zuin, M.; Rigatelli, G.; Picariello, C.; dell’Avvocata, F.; Marcantoni, L.; Pastore, G.; Carraro, M.; Nanjundappa, A.; Faggian, G.; Roncon, L. Correlation and prognostic role of neutrophil to lymphocyte ratio and SYNTAX score in patients with acute myocardial infarction treated with percutaneous coronary intervention: A six-year experience. Cardiovasc. Revasc. Med., 2017, 18(8), 565-571.
[http://dx.doi.org/10.1016/j.carrev.2017.05.007] [PMID: 28529092]
[21]
Bobryshev, Y.V. Monocyte recruitment and foam cell formation in atherosclerosis. Micron, 2006, 37(3), 208-222.
[http://dx.doi.org/10.1016/j.micron.2005.10.007] [PMID: 16360317]
[22]
Rosenson, R.S.; Brewer, H.B., Jr; Davidson, W.S.; Fayad, Z.A.; Fuster, V.; Goldstein, J.; Hellerstein, M.; Jiang, X.C.; Phillips, M.C.; Rader, D.J.; Remaley, A.T.; Rothblat, G.H.; Tall, A.R.; Yvan-Charvet, L. Cholesterol efflux and atheroprotection: Advancing the concept of reverse cholesterol transport. Circulation, 2012, 125(15), 1905-1919.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.111.066589] [PMID: 22508840]
[23]
Qi, H.; Yang, S.; Zhang, L. Neutrophil extracellular traps and endothelial dysfunction in atherosclerosis and thrombosis. Front. Immunol., 2017, 8, 928.
[http://dx.doi.org/10.3389/fimmu.2017.00928] [PMID: 28824648]
[24]
Jenča, D.; Melenovský, V.; Stehlik, J.; Staněk, V.; Kettner, J.; Kautzner, J.; Adámková, V.; Wohlfahrt, P. Heart failure after myocardial infarction: Incidence and predictors. ESC Heart Fail., 2021, 8(1), 222-237.
[http://dx.doi.org/10.1002/ehf2.13144] [PMID: 33319509]
[25]
Yu, C.; Zhou, W. Peripheral neutrophils and naive CD4 T cells predict the development of heart failure following acute myocardial infarction: A bioinformatic study. Revista. Portuguesa de Cardiologia (English Edition) ., 2021, 40(11), 839-847.
[http://dx.doi.org/10.1016/j.repce.2021.11.002] [PMID: 34857156]
[26]
Camici, P.G.; d’Amati, G.; Rimoldi, O. Coronary microvascular dysfunction: Mechanisms and functional assessment. Nat. Rev. Cardiol., 2015, 12(1), 48-62.
[http://dx.doi.org/10.1038/nrcardio.2014.160] [PMID: 25311229]
[27]
Garg, S.; Sarno, G.; Garcia-Garcia, H.M.; Girasis, C.; Wykrzykowska, J.; Dawkins, K.D.; Serruys, P.W. A new tool for the risk stratification of patients with complex coronary artery disease: The Clinical SYNTAX Score. Circ. Cardiovasc. Interv., 2010, 3(4), 317-326.
[http://dx.doi.org/10.1161/CIRCINTERVENTIONS.109.914051] [PMID: 20647561]
[28]
Kurtul, A.; Murat, S.N.; Yarlioglues, M.; Duran, M.; Ergun, G.; Acikgoz, S.K.; Demircelik, M.B.; Cetin, M.; Akyel, A.; Kasapkara, H.A.; Ornek, E. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am. J. Cardiol., 2014, 114(7), 972-978.
[http://dx.doi.org/10.1016/j.amjcard.2014.07.005] [PMID: 25118117]
[29]
Karabağ Y.; Rencuzogullari, I.; Çağdaş M.; Karakoyun, S.; Yesin, M.; Atalay, E.; Çağdaş Ö.S.; Gürsoy, M.O.; Burak, C.; Tanboğa, H.I. Association of serum uric acid levels with SYNTAX score II and long term mortality in the patients with stable angina pectoris who undergo percutaneous coronary interventions due to multivessel and/or unprotected left main disease. Int. J. Cardiovasc. Imaging, 2019, 35(1), 1-7.
[http://dx.doi.org/10.1007/s10554-018-1446-6] [PMID: 30143922]
[30]
Kurtul, A.; Murat, S.N.; Yarlioglues, M.; Duran, M.; Ocek, A.H.; Koseoglu, C. Celık, I.E.; Kilic, A.; Aksoy, O. Usefulness of Serum Albumin concentration to predict high coronary syntax score and in-hospital mortality in patients with acute coronary syndrome. Angiology, 2016, 67(1), 34-40.
[http://dx.doi.org/10.1177/0003319715575220] [PMID: 25783433]
[31]
He, C.; Song, Y.; Wang, C.; Yao, Y.; Tang, X.; Zhao, X.; Gao, R.; Yang, Y.; Xu, B.; Yuan, J. Prognostic value of the clinical syntax score on 2-year outcomes in patients with acute coronary syndrome who underwent percutaneous coronary intervention. Am. J. Cardiol., 2017, 119(10), 1493-1499.
[http://dx.doi.org/10.1016/j.amjcard.2017.02.031] [PMID: 28341359]
[32]
Çağdaş M.; Karakoyun, S.; Yesin, M.; Rencüzoğulları İ.; Karabağ Y.; Uluganyan, M.; Ozan Gürsoy, M.; Artaç, İ.; İliş D.; Atalay, E.; Sadioğlu Çağdaş Ö. The association between monocyte hdl-c ratio and syntax score and syntax score ii in stemi patients treated with primary PCI. Zhonghua Minguo Xinzangxue Hui Zazhi, 2018, 34(1), 23-30.
[PMID: 29375221]
[33]
Çiçek, G.; Kundi, H.; Bozbay, M.; Yayla, C.; Uyarel, H. The relationship between admission monocyte HDL-C ratio with short-term and long-term mortality among STEMI patients treated with successful primary PCI. Coron. Artery Dis., 2016, 27(3), 176-184.
[http://dx.doi.org/10.1097/MCA.0000000000000343] [PMID: 26751423]
[34]
Sim, D.S.; Ahn, Y.; Kim, Y.H.; Seon, H.J.; Park, K.H.; Yoon, H.J.; Yoon, N.S.; Kim, K.H.; Hong, Y.J.; Park, H.W.; Kim, J.H.; Jeong, M.H.; Cho, J.G.; Park, J.C. The relationship among n-terminal pro-b-type natriuretic peptide, high-sensitivity c-reactive protein and infarct size in patients with acute st-elevation myocardial infarction. Korean Circ. J., 2015, 45(4), 285-293.
[http://dx.doi.org/10.4070/kcj.2015.45.4.285] [PMID: 26240582]
[35]
Ji, H.; Li, Y.; Fan, Z.; Zuo, B.; Jian, X.; Li, L.; Liu, T. Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: a syntax score assessment. BMC Cardiovasc. Disord., 2017, 17(1), 90.
[http://dx.doi.org/10.1186/s12872-017-0507-4] [PMID: 28359298]
[36]
Li, H.; Meng, S.; Chen, W.; Lei, X.; Kong, X.; Zhu, H. Comparison of different systemic inflammatory markers in predicting clinical outcomes with syntax score in patients with non-st segment elevation myocardial infarction: A retrospective study. Int. J. Gen. Med., 2023, 16, 2595-2607.
[http://dx.doi.org/10.2147/IJGM.S413538] [PMID: 37362824]
[37]
Altunova, M. Karakayalı M.; Kahraman, S.; Avcı Y.; Demirci, G.; Sevinç, S.; Yazan, S.; Şahin, A.; Ertürk, M. Systemic immune-inflammatory index is associated with residual syntax score in patients with st-segment elevation myocardial infarction. Anatol. J. Cardiol., 2023, 27(8), 472-478.
[http://dx.doi.org/10.14744/AnatolJCardiol.2023.3074] [PMID: 37288857]
[38]
Han, K.; Shi, D.; Yang, L.; Wang, Z.; Li, Y.; Gao, F.; Liu, Y.; Ma, X.; Zhou, Y. Prognostic value of systemic inflammatory response index in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Ann. Med., 2022, 54(1), 1667-1677.
[http://dx.doi.org/10.1080/07853890.2022.2083671] [PMID: 35695557]
[39]
Li, Q.; Ma, X.; Shao, Q.; Yang, Z.; Wang, Y.; Gao, F.; Zhou, Y.; Yang, L.; Wang, Z. Prognostic impact of multiple lymphocyte-based inflammatory indices in acute coronary syndrome patients. Front. Cardiovasc. Med., 2022, 9, 811790.
[http://dx.doi.org/10.3389/fcvm.2022.811790] [PMID: 35592392]
[40]
Ibanez, B.; James, S.; Agewall, S.; Antunes, M.J.; Bucciarelli-Ducci, C.; Bueno, H.; Caforio, A.L.P.; Crea, F.; Goudevenos, J.A.; Halvorsen, S.; Hindricks, G.; Kastrati, A.; Lenzen, M.J.; Prescott, E.; Roffi, M.; Valgimigli, M.; Varenhorst, C.; Vranckx, P.; Widimský, P. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Kardiol. Pol., 2018, 76(2), 229-313.
[http://dx.doi.org/10.5603/KP.2018.0041] [PMID: 29457615]
[41]
Kinlay, S.; Schwartz, G.G.; Olsson, A.G.; Rifai, N.; Leslie, S.J.; Sasiela, W.J.; Szarek, M.; Libby, P.; Ganz, P. High-dose atorvastatin enhances the decline in inflammatory markers in patients with acute coronary syndromes in the MIRACL study. Circulation, 2003, 108(13), 1560-1566.
[http://dx.doi.org/10.1161/01.CIR.0000091404.09558.AF] [PMID: 12975259]
[42]
Budzianowski, J.; Pieszko, K.; Burchardt, P. Rzeźniczak, J.; Hiczkiewicz, J. The role of hematological indices in patients with acute coronary syndrome. Dis. Markers, 2017, 2017, 1-9.
[http://dx.doi.org/10.1155/2017/3041565] [PMID: 29109595]
[43]
Gijsberts, C.M.; den Ruijter, H.M.; de Kleijn, D.P.V.; Huisman, A.; ten Berg, M.J.; van Wijk, R.H.A.; Asselbergs, F.W.; Voskuil, M.; Pasterkamp, G.; van Solinge, W.W.; Hoefer, I.E. Hematological parameters improve prediction of mortality and secondary adverse events in coronary angiography patients. Medicine, 2015, 94(45), e1992.
[http://dx.doi.org/10.1097/MD.0000000000001992] [PMID: 26559287]
[44]
Sexton, T.R.; Wallace, E.L.; Macaulay, T.E.; Charnigo, R.J.; Evangelista, V.; Campbell, C.L.; Bailey, A.L.; Smyth, S.S. The effect of rosuvastatin on thromboinflammation in the setting of acute coronary syndrome. J. Thromb. Thrombolysis, 2015, 39(2), 186-195.
[http://dx.doi.org/10.1007/s11239-014-1142-x] [PMID: 25307674]

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