Hematological and leukocyte morphometric indices as low-cost diagnostic adjuncts in acute coronary syndromes

OBJECTIVE: Acute Coronary Syndromes (ACS) remain a major cause of morbidity and mortality, particularly in resource-limited settings where access to advanced diagnostics may be constrained. This study aimed to evaluate the utility of routine hematological indices and leukocyte morphometric parameters-volume, conductivity, and scatter (VCS)-as low-cost adjuncts for identifying ACS and differentiating its subtypes. RESULTS DESCRIPTION: This cross-sectional study included 291 adults (151 ACS patients and 140 healthy controls) evaluated between January 2022 and August 2023. Compared with controls, ACS patients had significantly higher total leukocyte counts, lower hemoglobin levels, increased mean platelet volume (MPV), reduced neutrophil conductivity (MN-C-NE), and increased monocyte scatter parameters (MN-LALS-MO, MN-AL2-MO) (all p < 0.01). On L1-regularized multivariable logistic regression, elevated WBC count, reduced hemoglobin, increased MPV, decreased neutrophil conductivity, and increased monocyte scatter indices independently predicted ACS. The combined model demonstrated excellent discriminatory performance (AUC 0.98 ± 0.02). However, discrimination between ACS subtypes was limited, with poor performance for differentiating STEMI from unstable angina and NSTEMI (AUC 0.63-0.65, p > 0.05). These findings suggest that hematological and VCS parameters are effective for identifying ACS but have limited utility in subtype differentiation.