The Role of Neutrophil to Lymphocyte Ratio and Platelet Indices as Markers of Inflammation in Acute Coronary Syndrome

Abstract Introduction Inflammation plays an important role in atherosclerosis that is the primary cause of acute coronary syndrome (ACS) which includes acute myocardial infarction (AMI) and unstable angina (UA). Objective To investigate neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), C-reactive protein (CRP), white blood cell (WBC) count and platelet count in patients with ACS. Patients and Methods This case control study included 50 patients with ACS (38 males, 12 females), aged 36 to 80 years, classified into three groups: ST segment elevation myocardial infarction group, non ST segment elevation myocardial infarction group and UA group. Patient group was compared to 50 apparently healthy subjects as a control group of matched age and sex. Patients were admitted to either the emergency department, cardiology outpatient clinic, or the coronary care unit (CCU) of Ain Shams University Hospitals. From patients’ medical records, the following data were obtained: WBC count, NLR, MPV, platelet count, C-reactive protein (CRP), troponin, total CK and creatine kinase MB (CKMB). The results were analyzed using software package SPSS. Results A highly statistically significant difference as regard WBC count, neutrophil count, NLR, MPV, and CRP level was found between ACS patients and healthy control group being higher in ACS patients. The study encountered a statistically significant difference among patients’ subgroups as regard NLR being higher in NSTEMI and lower in unstable angina. A statistically significant positive correlation between NLR and other parameters as WBCs count, neutrophil count, MPV and cardiac biomarkers was found. There was a statistically significant difference as regard MPV between ACS patients and control group. There was a statistically significant difference as regard CRP level between ACS patients and healthy control group. Conclusion NLR was high in ACS patients compared to controls. Median values of NLR were significantly higher in patients with AMI in relation to patients with UA, indicating the importance of this inflammatory marker in discrimination of clinical forms of ACS. A positive correlation was established between NLR and markers of myocardial necrosis, indicating the importance of NLR in the assessment of the extent of the myocardial lesion and in inflammation intensity assessment in ACS. The MPV is an independent risk factor for MI in coronary artery disease. The CRP has been found to be strongly associated with diagnosis and risk stratification of cardiovascular diseases.