Association Between Platelet-to-Lymphocyte Ratio and Coronary Artery Disease Severity in Chronic Coronary Syndrome

Background: Platelet-to-lymphocyte ratio (PLR) is a novel inflammatory biomarker linked to cardiovascular outcomes. However, its association with angiographic severity of coronary artery disease (CAD) in chronic coronary syndrome (CCS) is inadequately studied in the Bangladeshi population. The study aimed to evaluate the relationship between PLR and angiographic CAD severity using the Gensini score in CCS patients. Methods: A cross-sectional analytical study was conducted in the Department of Cardiology, BSMMU, from February 2022 to January 2023. Fifty-five CCS patients undergoing elective coronary angiography were enrolled. PLR was calculated from complete blood counts, and CAD severity was assessed via Gensini scoring. Severe CAD was defined as a score ≥25. Statistical analyses included Spearman’s correlation, multiple linear regression, and ROC curve analysis. Results: Severe CAD patients exhibited significantly higher PLR values (126 ± 11.8) compared to those with mild CAD (83.4 ± 16.7; p<0.001). PLR showed a moderate positive correlation with the Gensini score (r=0.458; p<0.001). A PLR cut‑off of 106.5 predicted severe CAD with 77.8% sensitivity and 78.9% specificity (AUC 0.787). In multivariate regression analysis, PLR remained an independent predictor alongside hypertension, diabetes mellitus, LDL cholesterol, and reduced LVEF, all of which were significantly associated with severe disease burden. Conclusion: PLR is significantly associated with angiographic CAD severity and may serve as a cost-effective marker for risk stratification in CCS patients. Incorporating PLR into standard diagnostic assessments could help identify individuals at higher risk for severe disease, enabling earlier interventions and improved allocation of healthcare resources, especially in resource-limited settings.