Role of Neutrophil to Lymphocyte Ratio (NLR) In Conjunction with Coronary Artery Involvement as a Biomarker for the Magnitude of Current of Injury, Type of Intervention and Clinical Outcomes in STEMI

Background: The potential prognostic biomarker—neutrophil to lymphocyte ratio (NLR) can be used to predict the severity of STEMI. We conducted an observational study using this parameter together with the extent of coronary artery involvement from coronary angiogram and magnitude of ST-elevation on ECG to determine the prognosis and the length of hospital stay. The effect of early reperfusion with thrombolysis was also observed.

Methods and Results: 30 subjects (age 56.43 ± 13.98), with ST-elevation on ECG at admission, treated with streptokinase and undergoing angiogram were taken for the study. Repeated ECGs and complete blood picture on admission day, day 3, day of discharge and on the follow-up day were obtained. Out of 30 subjects, 15 received thrombolysis out of which 12 (80%) survived compared to the other 15 subjects who presented late, out of which 10 (66.6%) survived. Mean ST-elevation on the day of admission, on day 3, day of discharge and on follow up was found to be 0.39 ± 0.12, 0.18 ± 0.12, 0.05 ± 0.07, 0.00 ± 0.00 respectively. NLR values on admission day were 7.89 ± 4.98, day 3 (6.24 ± 5.05), day of discharge (4.34 ± 2.74) and on follow up (1.71 ± 1.40) indicating association of higher NLR values with magnitude of current of injury. NLR values as high as 18.5 were observed in expired subjects. The length of hospital stay was found to be 6.43 ± 5.03 days.

Conclusion: There was a linear decrement in ST-segment resolution with a decrease in NLR and can be attributed to the natural course of disease and type of intervention provided. Nevertheless, the univariate correlation between ECG and NLR on various days of treatment was not significant.