Assessing the neutrophil-to-lymphocyte ratio as a biomarker for predicting the severity of coronary artery disease using Gensini Score

Objective: To evaluate the predictive value of neutrophil-to-lymphocyte ratio in assessing the severity of coronary artery disease, as determined by the Gensini score. Methodology: This retrospective study included 1,020 patients who underwent coronary angiography at the Rawalpindi Institute of Cardiology, Pakistan. The severity of coronary artery disease was classified using the Gensini scoring system. The association between neutrophil-to-lymphocyte ratio and disease severity was analyzed through univariate and multivariate logistic regression analysis. Receiver operating characteristic curve analysis was performed to evaluate its predictive ability. Results: Mean age of participants was 58.3±10.48 years, with 69.59% being male. Patients with very severe coronary artery disease had significantly higher neutrophil-to-lymphocyte ratios (mean = 5.93±10.94) compared to those without disease (mean = 2.77±3.44; p<0.001). Multivariate analysis confirmed the neutrophil-to-lymphocyte ratio as an independent predictor of disease severity (odds ratio = 1.021; 95% confidence interval: 1.008–1.035; p=0.002). The area under the curve was 0.60, indicating moderate discriminative capacity. Violin plot analysis revealed broader variability in very severe cases, reflecting complex inflammatory mechanisms. Conclusion: Neutrophil-to-lymphocyte ratio and its percentage were significantly elevated in very severe disease (p=0.0008), supporting their role as quantitative markers of coronary artery disease severity. Validation in larger, multi-center cohorts is recommended to assess utility in clinical risk stratification.