İbrahim RENCÜZOĞULLARI, Yavuz KARABAĞ, Metin ÇAĞDAŞ, Süleyman KARAKOYUN, Mahmut YESİN, İnanç ARTAÇ, Doğan İLİŞ, Bahattin BALCI

ST Segment Yüksekliği Olmayan Miyokard İnfarktüsü Hastalarında Nötrofil/Lenfosit Oranı ile SYNTAX ve SYNTAX II Skorları Arasındaki İlişkinin Değerlendirilmesi

Amaç: ST segment yüksekliği olmayan miyokard infarktüsü (NSTEMİ), koroner arter hastalarının (KAH) en sık prezantasyonlarından biridir. Syntax II skoru kompleks KAH olan hastaların mortalitesini predikte etmek için son zamanlarda geliştirilmiş iki anatomik ve altı klinik değişken içeren bir skorlama sistemidir. Nötrofil/lenfosit oranı (NLR) temel olarak bazal inflamatuvar cevabı yansıtan bir parametredir. Bu çalışmada; NSTEMİ hastalarında NLR ile KAH şiddeti arasındaki ilişkiyi Syntax skoru (SS) ve Syntax II skorunu (SSII) kullanarak araştırmak amaçlanmıştır. Materyal ve Metot: Şubat 2015 ile Haziran 2016 tarihleri arasında Kafkas Üniversitesi Tıp Fakültesi’ne başvuran ve koroner anjiyografi (KAG) uygulanan ardışık toplam 271 NSTEMİ hastası çalışmaya dahil edildi. Hastalardan periferik venöz kan alındı ve bu kanlardan NLR dahil bazı kan parametleri, biyokimyasal parametreler ile kardiyak biyobelirteçler çalışıldı. SS ile SSII hesaplandı. Bulgular: Çalışma grubu 194 NSTEMI hastasından (ort. yaş: 65 ± 12; %37.6 bayan hasta) oluştu. Daha öncesine ait SSII ile ilgili sınıflama olmaması nedeni ile hastalar medyan SSII değerine göre 2 gruba bölündü (SS II≤ 31.5 düşük skorlu grup [n = 97] ve >31.5 yüksek skorlu grup [n = 97]). SSII yüksek skorlu grupta NLR, SSII düşük skorlu gruba göre anlamlı olarak daha yüksekti (3.22 (2,30- 4,86) vs 4.05 (2,83-7,21) p=0,004). NLR ile SS arasında korelasyon bulunmazken (r=0.023, p=0.759), NLR ile SSII korele olarak izlendi (r=0.218, p=0.002). NLR’ nin SS ile korelasyonun bulunmayıp SSII ile korelasyonun bulunması nedeni ile NLR’ nin SSII bileşenleri ile korelasyon analizi yapıldı. Yapılan analizinde; NLR, sol ventrikül ejeksiyon fraksiyonu (r=-0.161, p=0.026) ve kreatin klirensi ile ilişkili olduğu izlendi (r=-0.161, p=0.025). Ancak NLR SSII’nin diğer parametrik değişkenleri ile ilişkili değildi. Sonuç: Sonuç olarak çalışmamızda NLR, SS ile ilişkili olmayıp, SSII ile ilişkilidir. Yüksek NLR, SSII yüksek skorlu hastaları predikte edebilir ve SSII’yi predikte etmesi anatomik skor sisteminden ziyade komorbiditeler ile alakalıdır.

Anahtar Kelimeler:

nötrofil/lenfosit oranı; Syntax II skoru; ST segment yüksekliği olmayan miyokard infarktüsü

Assessment of Relationship Between SYNTAX and SYNTAX II Scores and Neutrophil/Lymphocyte Ratio in Patients with Non-ST Segment Elevation Myocardial Infarction

Aim: Non ST segment elevation myocardial infarction (NSTEMI) is one of the most common presentations of coronary arterial disease (CAD). Syntax II score (SSII) is a recently developed scoring system consisting two anatomical and six clinical variables which is used to predict mortality of patients with complex CAD. Neutrophil/lymphocyte ratio (NLR) basically shows basal inflammatory response. The aim of our study was to evaluate the relationship between NLR and CAD severity using Syntax score (SS) and SSII in NSTEMI patients. Material and Method: Consecutive 271 NSTEMI patients who referred to Kafkas University between February 2015 and June 2016 and underwent coronary angiography have been included in this study. Peripheral venous blood samples were taken from all patients. Hemogram parameters including NLR, biochemical parameters and cardiac biomarkers were evaluated. SS and SSII were calculated from recorded coronary angiograms. Results: The study population consisted of 194 NSTEMI patients. Due to the fact that there was no definitive previous classification of SSII, the patients were divided into 2 groups according to median SSII value. (SSII<31.5 low score group [n=97] and >31.5 high score group [n=97]. NLR was significantly higher at SSII high score group than low score group 3.22 (2.30-4.86) vs 4.05 (2.83-7.21) p=0.004). While there was no correlation between NLR and SS (r=0.023, p=0.759), there was a correlation between NLR and SSII (r=0.218, p=0.002). Therefore correlation analysis was performed between NLR and SSII components. Our analysis demonstrated that there was a correlation between NLR and left ventricular ejection fraction (r=-0.161, p=0.026), as well as between NLR and creatinine clearance (r=-0.161, p=0.025). However, there was no correlation with other parametric components of SSII. Conclusion: Our study demonstrated that there was a correlation between NLR and SSII, but no correlation between NLR and SS. High NLR can predict that patients have high SSII scores, and this prediction is related to comorbidities rather than anatomical score system.

Keywords:

neutrophil/lymphocyte ratio; Syntax II score non-ST segment elevation myocardial infarction,

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1. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010;362:2155–65.
2. Terkelsen CJ, Lassen JF, Norgaard BL, Gerdes JC, Jensen T, Gøtzsche LB, et al. Mortality rates in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: observations from an unselected cohort. Eur Heart J 2005;26:18–26.
3. Goldberg RJ, Steg PG, Sadiq I, Granger CB, Jackson EA, Budaj, A et al. Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). Am J Cardiol 2002;89:791–6.
4. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: An angiographic tool grading the complexity of coronary artery disease. EuroInterventio 2005;1:219–27.
5. Van Gaal WJ, Ponnuthurai FA, Selvanayagam J, Testa L, Porto I, Neubauer S, et al. The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention. Int J Cardiol 2009;135:60–5.
6. Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J, et al. Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization. Am J Cardiol 2011;107:360–6.
7. Serruys PW, Onuma Y, Garg S, Vranckx P, De Bruyne B, Morice MC, et al 5-year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J Am Coll Cardiol 2010;55:1093–101. 8. Chakrabarti AK, Gibson CM. The SYNTAX score: usefulness, limitations, and future directions. J Invasive Cardiol 2011;23:511–2.
9. Farooq V, van Klaveren D, Steyerberg EW, Meliga E, Vergouwe Y, Chieffo A, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery andpercutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet 2013;381(9867):639–50.
10. Campos CM, van Klaveren D, Iqbal J, Onuma Y, Zhang YJ, GarciaGarcia HM, et al. Predictive Performance of SYNTAX Score II in Patients With Left Main and Multivessel Coronary Artery Disease. Circ J 2014;78:1942–9.
11. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105:1135–43.
12. Pereira IA, Borba EF. The role of inflammation, humoral and cellmediated autoimmunity in the pathogenesis of atherosclerosis. Swiss Med Wkly 2008;138:534–9.
13. Widmer A, Linka AZ, Attenhofer Jost CH, Buergi B, BrunnerLa Rocca HP, Salomon F, et al. Mechanicalcomplications after myocardial infarction reliably predictedusing C-reactive protein levels and lymphocytopenia. Cardiology 2003;99(1):25 31.
14. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lym-phocyte concentration as a prognostic marker in coronary arterydisease. Am J Cardiol 1997;79(6):812–4.
15. Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CG, Thomson SP, Gibbons RJ. Predictive powerof the relative lymphocyte concentration in patients with advanced heart failure. Circulation 1998;97(1):19–22.
16. Soylu K, Gedikli Ö, Dagasan G, Aydin E, Aksan G, Nar G, et al. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome. Rev Port Cardiol 2015;34(7–8):465–71.
17. Sahin DY, Elbasan Z, Gür M, Yildiz A, Akpinar O, Icen YK, et al. Neutrophil to lymphocyteratio is associated with the severity of coronary artery diseasein patients with ST-segment elevation myocardial infarction. Angiol 2013;64(6):423–9.
18. Altun B, Turkon H, Tasolar H, Beggı H, Altun M, Temız A, et al. The relationshipbetween high-sensitive troponin T, neutrophil lymphocyteratio and SYNTAX score. Scand J Clin Lab Invest 2014;74(2):108–15.
19. Magro M, Nauta S, Simsek C, Onuma Y, Garg S, van der Heide E, et al. Value of the SYNTAX score in patients treated by primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: The MI SYNTAX score study. Am Heart J 2011;161:771–81.
20. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105(9):1135–43.
21. Hansen PR. Role of neutrophils in myocardial ischemia andreperfusion. Circulation 1995;91:1872–85.
22. Mehta J, Dinerman J, Mehta P, Saldeen TG, Lawson D, Donnelly WH, et al. Neutrophil function in ischemic heart disease. Circulation 1989;79(3):549–56.
23. Widmer A, Linka AZ, Attenhofer Jost CH, Buergi B, BrunnerLa Rocca HP, Salomon F, et al. Mechanical complications after myocardial infarction reliably predicted using C-reactive protein levels and lymphocytopenia. Cardiology 2003;99(1):25–31.
24. Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lmphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol 2000;15;86(4):449–51.
25. Blum A, Sclarovsky S, Rehavia E, Shohat B. Levels of T-lymphocyte subpopulations, interleukin-1beta, and soluble interleukin-2 receptor in acute myocardial infarction. Am Heart J 1994;127:1226–30.
26. Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, et al. Usefulness of neutrophilto lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol 2010;106:470–6.
27. Manginas A, Bei E, Chaidaroglou A, Degiannis D, Koniavitou K, Voudris V, et al. Peripheral levels of matrix metalloproteinase-9, interleukin-6, and C-Reactive protein are elevated in patientswith acute coronary syndromes: correlations with serum troponin I. Clin Cardiol 2005;28(4):182–6.
28. Mazzone A, De Servi S, Mazzucchelli I, Bossi I, Ottini E, Vezzoli M, et al. Increased concentrations of inflammatory mediators in unstable angina: correlation with serum troponin T. Heart 2001;85(5):571–5.
29. Shlipak MG, Fried LF, Crump C, Bleyer AJ, Manolio TA, Tracy RP, et al. Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency. Circulation 2003;107:87–92.
30. Kshirsagar AV, Bomback AS, Bang H, Gerber LM, Vupputuri S, Shoham DA, et al. Association of C-reactive protein and microalbuminuria (from the National Health and Nutrition Examination Surveys, 1999 to 2004). Am J Cardiol 2008;101:401–6.
31. Tonelli M, Sacks F, Pfeffer M, Jhangri GS, Curhan G. Biomarkers of inflammation and progression of chronic kidney disease. KidneyInt 2005;68(1):37–245.
32. Tian N, Penman AD, Manning RD Jr, Flessner MF, Mawson AR. Association between circulating specific leukocyte types and incident chronic kidney disease: theAtherosclerosis Risk in Communities (ARIC) study. J Am Soc Hypertens 2012;6(2):100–8.
33. Azab B, Daoud J, Naeem B. F, Nasr R, Ross J, Ghimire P, et al. Neutrophil-to-Lymphocyte Ratio as a Predictor of Worsening Renal Function in Diabetic Patients(3-Year Follow-Up Study) 2012;34(5):571–6.
34. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic ob¬structive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187:347–65.
35. Celli BR, Locantore N, Yates J, Tal-Singer R, Miller BE, Bakke P, et al. Inflammatory biomarkers improve clinical prediction of mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012;185:1065–72.
36. Sørensen AK, Holmgaard DB, Mygind LH, Johansen J, Pedersen C. Neutrophil-to-lymphocyte ratio, calprotectin and YKL-40 in patients with chronic obstructive pulmonary disease: correlations and 5-year mortality-a cohort study. J Inflamm 2015;12:20.
37. Lee H, Um SJ, Kim YS, Kim DK, Jang AS, Choi HS, et al. Association of the Neutrophil-to-Lymphocyte Ratio with Lung Function and Exacerbations in Patients withChronic Obstructive Pulmonary Disease. PLoS One 2016;11(6): e0156511.
38. Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensate heart failure. Am J Cardiol 2011;107:433–8.
39. Bekler A, Erbag G, Sen H, Gazi E, Ozcan S. Predictive value of elevated neutrophil- lymphocyte ratio for left ventricular systolic dysfunction in patientswith non ST- elevated acute coronary syndrome. Pak J Med Sci 2015;31(1):159–63.
40. Karakas MS, Korucuk N, Tosun V, Altekin RE, Koç F, Ozbek SC, et al. Red cell distribution width and neutrophil-to-lymphocyte ratio predict left ventricular dysfunction in acuteanterior STsegment elevation myocardial infarction. J Saudi Heart Assoc 2016;28(3):152–8.
41. Wasilewski J, Pyka Ł, Hawranek M, Osadnik T, Kurek A, Skrzypek M, et al. Prognostic value of neutrophil to lymphocyte ratio in predicting long-term mortality in patients with ischemicand nonischemic heart failure. Pol Arch Med Wewn 2016;126(3):166–73.