Evaluation of the platelet-to-white-cell ratio (PWR) as predictor of long-term all-cause mortality in patients with acute myocardial infarction

The platelet-to-white-cell ratio has recently gained attention as a potential prognostic indicator. This study investigated the association between platelet-to-white-cell ratio at admission and long-term mortality in acute myocardial infarction patients, in comparison to leukocyte and platelet counts alone. The study included 4,964 patients aged 25-84 years with incident acute myocardial infarction hospitalized between 2010 and 2017, as recorded in the population-based Augsburg Myocardial Infarction Register. Platelet-to-white-cell ratio was calculated from admission platelets divided by leukocyte counts. Cox proportional hazards regression models were used to assess the associations between quartiles of platelet-to-white-cell ratio, of leukocytes, and of platelets with long-term all-cause mortality. During a median follow-up time of 4.7 years, 1,224 patients died. Platelet count in the highest quartile was observed to be associated with increased mortality risk (HR 1.32 (1.06-1.63). Platelet-to-white-cell ratio values were also found to be associated with risk of mortality. Multivariable adjusted HRs for the second, third, and fourth quartiles of platelet-to-white-cell ratio (vs. lowest quartile) were 0.64 (95% CI: 0.52-0.80), 0.83 (0.67-1.03), and 0.78 (0.62-0.98), respectively. Platelet-to-white-cell ratio at admission was associated with long-term mortality in patients with acute myocardial infarction. As a simple, cost-effective biomarker, platelet-to-white-cell ratio may support individualized risk stratification and clinical decision-making in acute myocardial infarction care.