Predictive Value of Neutrophil-Lymphocyte Ratio for Long-Term Cardiovascular Event Following Coronary Artery Bypass Grafting

Abstract

Objective: To investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) for long-term major adverse cardiac and cerebrovascular events (MACCE), which have not yet been well described, in patients undergoing coronary artery bypass grafting (CABG).

Methods: The records of 751 consecutive patients who underwent elective CABG between January 2008 and January 2010 were retrospectively enrolled and stratified according to quartiles of preoperative NLR. At 7.8-year follow-up, MACCE was considered as an endpoint.

Results: Overall MACCE was 11.6% of all cases. Long-term myocardial infarction, percutaneous coronary intervention, stroke and cardiovascular mortality were found associated with the upper NLR quartile (P<0.001, P<0.001, P=0.005, P<0.001, respectively). In multivariate analysis, NLR on admission remained an independent predictor of long-term MACCE (OR 1.087, 95% CI 1.026-1.151; P=0.004), in all EuroSCORE risk groups (P<0.001; P<0.001; P=0.029). The receiver operating characteristic (ROC) curve analyses revealed an NLR cut-off value of 4.32 predicting MACCE.

Conclusion: NLR is a useful and readily available predictive marker of long-term MACCE following CABG, independent of the EuroSCORE.

Keywords: Coronary Artery Bypass; Lymphocytes; Myocardial Infarction; Neutrophils; Percutaneous Coronary Intervention; Stroke.

Fig. 1

Kaplan-Meier estimates of survival free of cardiovascular death, stroke, myocardial infarction and repeated coronary revascularization (P<0.001 by the log-rank test). Q=quartile

Fig. 2

ROC curve analysis. The diagonal represents the no-effect line (AUC=0.50), with curves above this line representing increasing diagnostic accuracy. NLR accurately predicted MACCE (AUC=0.74). The circle represents the optimal cut-off to predict MACCE with a sensitivity of 50.6% and specificity of 92%. AUC=area under the curve