Background
Methods
Patients and study design
Blood sampling and definitions of CAD risk factors
Coronary angiography and Gensini score
Outcomes
Statistical analysis
Results
Characteristics of patients according to NLR
1st tertile ≤ 3.37 (n = 245) | 2nd tertile 3.38–6.93 (n = 245) | 3rd tertile ≥ 6.94 (n = 247) | t/Z/χ2 | P | |
---|---|---|---|---|---|
Sex (male/female) | 200/45 | 203/42 | 213/34 | 2.039 | 0.361 |
Age (years) | 58.20 ± 12.46 | 57.20 ± 12.45 | 58.64 ± 12.04 | 0.877 | 0.417 |
Hypertension | 113 (46.1) | 115 (46.9) | 103 (41.7) | 1.582 | 0.453 |
Diabetes mellitus | 76 (31.0) | 64 (26.1) | 53 (21.5) | 5.820 | 0.054 |
DM treatment | 3.808 | 0.433 | |||
Diet only | 4 (6.6) | 2 (3.6) | 2 (4.9) | ||
Oral hypoglycemic drugs | 23 (37.7) | 30 (54.5) | 21 (51.2) | ||
Insulin | 34 (55.7) | 23 (41.8) | 18 (43.9) | ||
Smoking | 9.319 | 0.054 | |||
Never smoker | 110 (44.9) | 132 (53.9) | 115 (46.6) | ||
Former smoker | 19 (7.8) | 7 (2.9) | 11 (4.5) | ||
Current smoker | 116 (47.3) | 106 (43.3) | 121 (49.0) | ||
Alcohol drinking | 2.390 | 0.664 | |||
Never drinking | 151 (61.9) | 149 (61.3) | 146 (59.3) | ||
Former drinking | 35 (14.3) | 35 (14.4) | 46 (18.7) | ||
Current drinking | 58 (23.8) | 59 (24.3) | 54 (22.0) | ||
Family history of CAD | 99 (40.4) | 101 (41.2) | 97 (39.3) | 0.197 | 0.906 |
SBP (mmHg) | 122.02 ± 20.97 | 122.91 ± 19.32 | 122.21 ± 19.17 | 0.137 | 0.872 |
DBP (mmHg) | 75.96 ± 13.59 | 76.75 ± 12.90 | 77.23 ± 13.84 | 0.567 | 0.567 |
Heart rate (bpm) | 82.78 ± 15.31 | 80.54 ± 14.71 | 82.50 ± 15.03 | 1.618 | 0.199 |
BMI (kg/m2) | 25.11 ± 5.28 | 25.04 ± 5.15 | 24.63 ± 5.94 | 0.475 | 0.622 |
HDL-C (mmol/l) | 0.95 ± 0.26 | 1.00 ± 0.26 | 1.01 ± 0.26 | 2.575 | 0.077 |
LDL-C (mmol/l) | 2.93 ± 0.91 | 2.96 ± 0.84 | 2.97 ± 0.85 | 0.095 | 0.910 |
TC (mmol/l) | 4.61 ± 1.22 | 4.66 ± 1.26 | 4.59 ± 1.08 | 0.181 | 0.834 |
TG (mmol/l) | 1.76 ± 1.13 | 2.04 ± 1.06a | 2.26 ± 1.17ab | 11.988 | < 0.001 |
ApoA1 (g/L) | 1.21 ± 0.29 | 1.28 ± 0.53 | 1.22 ± 0.27 | 1.604 | 0.202 |
ApoB (g/L) | 0.92 ± 0.49 | 0.90 ± 0.27 | 0.91 ± 0.26 | 0.160 | 0.852 |
Lp (a) (g/L) | 244.88 ± 258.72 | 236.56 ± 227 | 239.63 ± 214.2 | 0.059 | 0.942 |
Creatinine (mmol/L) | 79.27 ± 36.5 | 81.75 ± 56.31 | 79.25 ± 35.77 | 0.259 | 0.772 |
BUN (mmol/l) | 5.42 ± 2.76 | 5.69 ± 2.26 | 5.68 ± 2.81 | 0.833 | 0.435 |
Uric acid (mmol/L) | 334.27 ± 90.96 | 326.4 ± 88.92 | 325.73 ± 99.45 | 0.629 | 0.534 |
WBC | 9.03 ± 3.21 | 11.05 ± 3.35a | 12.32 ± 3.41ab | 61.212 | < 0.001 |
Monocyte count | 0.63 ± 0.24 | 0.66 ± 0.34 | 0.46 ± 0.32ab | 30.768 | < 0.001 |
PLR | 89.94 ± 36.52 | 145.34 ± 110.94a | 265.13 ± 175.65ab | 132.705 | < 0.001 |
RBC | 4.77 ± 0.72 | 4.85 ± 0.58 | 4.65 ± 0.82b | 4.852 | 0.008 |
HGB | 145.04 ± 22.16 | 144.99 ± 26.14 | 142.53 ± 28.78 | 0.759 | 0.468 |
PLT | 224.49 ± 71.94 | 229.48 ± 144.24 | 236.26 ± 162.19 | 0.492 | 0.612 |
MPV | 10.16 ± 1.43 | 10.26 ± 1.24 | 10.14 ± 1.66 | 0.499 | 0.608 |
PDW | 13.36 ± 3.83 | 13.43 ± 3.71 | 13.31 ± 3.22 | 0.065 | 0.937 |
PCT | 0.24 ± 0.08 | 0.23 ± 0.09 | 0.25 ± 0.12 | 1.632 | 0.196 |
Clinical diagnosis | 20.160 | < 0.001 | |||
UA | 52 (21.2) | 29 (11.8) | 19 (7.7) | ||
NSTEMI | 26 (10.7) | 30 (12.2) | 31 (12.6) | ||
STEMI | 167 (68.2) | 186 (75.9) | 197 (79.8) | ||
Coronary artery lesion | |||||
UPLMT | 22 (9.2) | 25 (10.6) | 21 (8.7) | 0.526 | 0.769 |
LAD | 217 (88.9) | 211 (86.5) | 216 (87.8) | 0.687 | 0.709 |
LCX | 155 (64.3) | 147 (61.0) | 155 (63.0) | 0.577 | 0.749 |
RCA | 179 (74.0) | 178 (73.3) | 186 (75.3) | 0.278 | 0.870 |
Medication situation | |||||
Aspirin | 20 (8.2) | 32 (13.1) | 22 (8.9) | 3.782 | 0.151 |
Statins | 18 (7.3) | 28 (11.4) | 21 (8.5) | 2.625 | 0.269 |
β-Blockers | 16 (6.5) | 16 (6.5) | 12 (4.9) | 0.818 | 0.664 |
ACEI/ARB | 8 (3.3) | 13 (5.3) | 6 (2.4) | 3.049 | 0.218 |
CCB | 41 (16.7) | 26 (10.6) | 35 (14.2) | 3.885 | 0.143 |
Incidence of mortality and MACEs according to the NLR
1st tertile ≤ 3.37 (n = 245) | 2nd tertile 3.38–6.93 (n = 245) | 3rd tertile ≥ 6.94 (n = 247) | χ2 | P | |
---|---|---|---|---|---|
ACM, n (%) | 5 (2.0) | 12 (4.9) | 7 (2.8) | 3.385 | 0.184 |
Non-sudden cardiac death, n (%) | 1 (0.4) | 0 (0.0) | 0 (0.0) | 1.825 | 0.665 |
MACE, n (%) | 21 (8.6) | 24 (9.8) | 20 (8.1) | 0.469 | 0.791 |
CM, n (%) | 4 (1.6) | 12 (4.9) | 7 (2.8) | 4.421 | 0.110 |
Re-myocardial infarction, n (%) | 4 (1.6) | 0 (0.0) | 2 (0.8) | 5.578 | 0.061 |
ST, n (%) | 0 (0.0) | 0 (0.0) | 2 (0.8) | 2.617 | 0.332 |
Revascularization, n (%) | 11 (4.5) | 17 (6.9) | 12 (4.9) | 1.666 | 0.435 |
Stroke, n (%) | 1 (0.4) | 0 (0.0) | 2 (0.8) | 2.764 | 0.251 |
Bleeding events, n (%) | 1 (0.4) | 6 (2.4) | 1 (0.4) | 5.904 | 0.052 |
Characteristics of patients according to GS
1st tertile ≤ 45 (n = 250) | 2nd tertile 49–85 (n = 246) | 3rd tertile ≥ 85 (n = 241) | t/Z/χ2 | P | |
---|---|---|---|---|---|
Sex (male/female) | 171/79 | 191/55 | 200/41 | 14.814 | 0.001 |
Age (years) | 55.37 ± 12.26 | 58.23 ± 11.84a | 60.53 ± 12.34ab | 11.111 | < 0.001 |
Hypertension | 106 (42.4) | 111 (45.1) | 114 (47.3) | 1.199 | 0.549 |
Diabetes mellitus | 45 (18.0) | 66 (26.8) | 82 (34.0)ab | 16.381 | < 0.001 |
Diabetes mellitus treatment | 0.846 | 0.932 | |||
Diet only | 2 (4.2) | 3 (6.7) | 3 (4.7) | ||
Oral hypoglycemic drugs | 23 (47.9) | 19 (42.2) | 32 (50.0) | ||
Insulin | 23 (47.9) | 23 (51.1) | 29 (45.3) | ||
Smoking | 9.963 | 0.041 | |||
Never smoker | 134 (53.6) | 119 (48.4) | 104 (43.2) | ||
Former smoker | 16 (6.4) | 13 (5.3) | 8 (3.3) | ||
Current smoker | 100 (40.0) | 114 (46.3) | 129 (53.5) | ||
Alcohol drinking | 1.053 | 0.902 | |||
Never drinking | 147 (58.8) | 153 (63.2) | 146 (60.6) | ||
Former drinking | 41 (16.4) | 36 (14.9) | 39 (16.2) | ||
Current drinking | 62 (24.8) | 53 (21.9) | 56 (23.2) | ||
Family history of CAD | 95 (38.0) | 100 (40.7) | 102 (42.3) | 0.972 | 0.615 |
SBP (mmHg) | 123.72 ± 20.64 | 122.37 ± 18.87 | 121 ± 19.85 | 1.157 | 0.315 |
DBP (mmHg) | 76.86 ± 13.88 | 77.45 ± 13.12 | 75.62 ± 13.3 | 1.174 | 0.310 |
Heart rate | 80.42 ± 14.05 | 81.78 ± 14.26 | 83.68 ± 16.58 | 2.930 | 0.054 |
BMI (kg/m2) | 24.78 ± 5.95 | 24.9 ± 5.05 | 25.11 ± 5.36 | 0.203 | 0.817 |
HDL-C (mmol/l) | 0.96 ± 0.23 | 0.99 ± 0.26 | 1.01 ± 0.28 | 2.152 | 0.117 |
LDL-C (mmol/l) | 2.88 ± 0.85 | 2.94 ± 0.74 | 3.04 ± 1 | 1.434 | 0.239 |
TC (mmol/l) | 4.63 ± 1.23 | 4.57 ± 0.98 | 4.68 ± 1.34 | 0.374 | 0.688 |
TG (mmol/l) | 2.14 ± 2.15 | 2.15 ± 2.13 | 1.98 ± 1.45 | 0.426 | 0.653 |
ApoA1 (g/L) | 1.2 ± 0.26 | 1.23 ± 0.3 | 1.29 ± 0.53 | 2.710 | 0.067 |
ApoB (g/L) | 0.9 ± 0.27 | 0.88 ± 0.23 | 0.96 ± 0.52 | 2.433 | 0.089 |
Lp(a) (g/L) | 234.48 ± 232.84 | 263.47 ± 280.29 | 222 ± 172.39 | 1.505 | 0.223 |
Cr (mmol/L) | 80.9 ± 35.25 | 80.52 ± 42.9 | 78.84 ± 52.29 | 0.150 | 0.860 |
BUN (mmol/l) | 5.71 ± 2.91 | 5.59 ± 2.87 | 5.5 ± 1.95 | 0.394 | 0.674 |
Uric acid (μmol/L) | 326.22 ± 92.64 | 335.89 ± 94.27 | 324.19 ± 92.59 | 1.090 | 0.337 |
WBC | 10.88 ± 3.74 | 10.87 ± 3.71 | 10.64 ± 3.29 | 0.339 | 0.712 |
Neutrophil count | 8.13 ± 3.63 | 8.37 ± 3.58 | 8.11 ± 3.15 | 0.419 | 0.658 |
lymphocyte count | 1.95 ± 1.27 | 1.76 ± 0.96 | 1.81 ± 1.07 | 1.954 | 0.142 |
NLR | 5.24 ± 3.90 | 6.41 ± 5.24 | 7.46 ± 5.51 | 12.506 | < 0.001 |
NLR tertiles | 19.287 | 0.001 | |||
1st tertile | 104 (41.6) | 77 (31.3) | 64 (26.6) | ||
2nd tertile | 84 (33.6) | 84 (34.1) | 77 (32.0) | ||
3rd tertile | 62 (24.8) | 85 (34.6) | 100 (41.5) | ||
Monocyte count | 0.59 ± 0.32 | 0.58 ± 0.32 | 0.57 ± 0.31 | 0.258 | 0.773 |
PLR | 158.09 ± 122.37 | 176.51 ± 159.31 | 166.74 ± 142.57 | 1.042 | 0.353 |
RBC | 4.75 ± 0.70 | 4.74 ± 0.73 | 4.79 ± 0.72 | 0.399 | 0.672 |
HGB | 145.15 ± 24.97 | 142.77 ± 27.85 | 144.62 ± 24.6 | 0.579 | 0.561 |
PLT | 223.74 ± 69.67 | 242.01 ± 203.23 | 224.52 ± 77.66 | 1.508 | 0.222 |
MPV | 10.20 ± 1.29 | 10.16 ± 1.75 | 10.2 ± 1.28 | 0.065 | 0.937 |
PDW | 13.66 ± 3.35 | 13.44 ± 3.78 | 12.98 ± 3.63 | 2.298 | 0.101 |
PCT | 0.24 ± 0.08 | 0.24 ± 0.11 | 0.24 ± 0.10 | 0.239 | 0.788 |
Clinical diagnosis | 1.672 | 0.796 | |||
UA | 38 (15.2) | 32 (13.0) | 30 (12.4) | ||
NSTEMI | 32 (12.8) | 26 (10.6) | 29 (12.0) | ||
STEMI | 180 (72.0) | 188 (76.4) | 182 (75.5) | ||
Aspirin | 18 (7.2) | 23 (9.3) | 33 (13.7) | 5.923 | 0.052 |
Statins | 17 (6.8) | 19 (7.7) | 31 (12.9)ab | 6.029 | 0.043 |
β-Blockers | 15 (6.0) | 12 (4.9) | 17 (7.1) | 1.027 | 0.598 |
ACEI/ARB | 7 (2.8) | 8 (3.3) | 12 (5.0) | 1.828 | 0.401 |
CCB | 32 (12.8) | 34 (13.8) | 36 (14.9) | 0.470 | 0.790 |
Factors associated with coronary lesion severity as detected by Gensini Score
Variables | B | SE | Wald | P | HR | 95% CI | |
---|---|---|---|---|---|---|---|
Lower limit | Upper limit | ||||||
Age | 0.032 | 0.006 | 27.046 | < 0.001 | 1.033 | 1.020 | 1.045 |
Sex (male vs female) | 0.607 | 0.173 | 12.363 | < 0.001 | 1.835 | 1.309 | 2.575 |
Diabetes mellitus (No vs Yes) | − 0.680 | 0.163 | 17.508 | < 0.001 | 0.507 | 0.368 | 0.696 |
Smoking | |||||||
Never smoker vs current drinking | − 0.178 | 0.152 | 2.501 | 0.079 | 0.837 | 0.216 | 1.255 |
Former smoker vs current drinking | − 0.237 | 0.171 | 3.390 | 0.059 | 0.790 | 0.310 | 1.098 |
Statins | − 0.470 | 0.245 | 3.666 | 0.056 | 0.625 | 0.386 | 1.011 |
NLR group | |||||||
1st tertile vs 3rd tertile | − 0.640 | 0.174 | 13.526 | < 0.001 | 0.527 | 0.375 | 0.742 |
2nd tertile vs 3rd tertile | − 0.747 | 0.334 | 4.993 | 0.025 | 0.474 | 0.246 | 0.912 |
Predictors of clinical outcomes
Variables | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
HR | 95% CI | P | HR | 95% CI | P | |
Sex (Male/Female) | 1.275 | 0.694–2.342 | 0.433 | |||
Age | 1.051 | 1.029–1.073 | < 0.001 | 1.049 | 1.024–1.075 | < 0.001 |
Hypertension | 0.918 | 0.562–1.499 | 0.731 | |||
Diabetes mellitus | 1.175 | 0.676–2.044 | 0.568 | |||
Smoking | ||||||
Former smoker vs never smoker | 1.177 | 0.161–8.616 | 0.872 | |||
Current smoker vs never smoker | 0.842 | 0.516–1.374 | 0.490 | |||
Alcohol drinking | ||||||
Former smoker vs never drinking | 1.061 | 0.526–2.139 | 0.868 | |||
Current smoker vs never drinking | 1.390 | 0.797–2.423 | 0.246 | |||
Family history of CAD | 0.876 | 0.529–1.450 | 0.605 | |||
SBP (mmHg) | 1.029 | 1.016–1.042 | < 0.001 | 1.029 | 1.009–1.049 | 0.005 |
DBP (mmHg) | 1.040 | 1.019–1.059 | < 0.001 | 1.007 | 0.978–1.038 | 0.626 |
Heart rate | 1.008 | 0.992–1.024 | 0.319 | |||
BMI | 0.965 | 0.928–1.003 | 0.072 | |||
HDL-C (mmol/l) | 2.371 | 0.909–6.183 | 0.078 | |||
LDL-C (mmol/l) | 1.238 | 0.913–1.680 | 0.169 | |||
TC (mmol/l) | 1.132 | 0.905–1.416 | 0.278 | |||
TG (mmol/l) | 0.956 | 0.813–1.123 | 0.583 | |||
ApoA1 (g/L) | 1.170 | 0.662–2.067 | 0.589 | |||
ApoB (g/L) | 1.118 | 0.574–2.181 | 0.742 | |||
Lp(a) (g/L) | 0.999 | 0.997–1.001 | 0.150 | |||
Creatinine (mmol/L) | 1.001 | 0.994–1.006 | 0.995 | |||
BUN (mmol/l) | 0.978 | 0.881–1.086 | 0.675 | |||
Uric acid (μmol/L) | 1.001 | 0.997–1.003 | 0.980 | |||
NLR group | ||||||
2nd tertile vs 1st tertile | 1.155 | 0.643–2.075 | 0.629 | |||
3rd tertile vs 1st tertile | 0.940 | 0.509–1.734 | 0.843 | |||
Monocyte count | 0.923 | 0.427–1.996 | 0.839 | |||
PLR | 1.001 | 0.999–1.002 | 0.080 | |||
RBC | 1.534 | 1.015–2.318 | 0.042 | 1.452 | 0.991–1.038 | 0.056 |
HGB | 1.002 | 0.993–1.012 | 0.660 | |||
PLT | 1.001 | 0.999–1.002 | 0.550 | |||
MPV | 1.001 | 0.847–1.180 | 0.997 | |||
PDW | 0.946 | 0.882–1.016 | 0.126 | |||
PCT | 1.654 | 0.177–15.465 | 0.659 | |||
WBC | 0.979 | 0.913–1.049 | 0.540 | |||
Clinical diagnosis | ||||||
NSTEMI | 1.062 | 0.386–2.9222 | 0.907 | |||
STEMI | 0.862 | 0.3692.012 | 0.731 | |||
UPLMT | 2.446 | 1.301–4.599 | 0.006 | 1.466 | 0.763–2.816 | 0.251 |
LAD | 2.155 | 0.783–5.929 | 0.137 | |||
LCX | 1.430 | 0.836–2.445 | 0.191 | |||
RCA | 2.186 | 1.080–4.423 | 0.030 | 1.242 | 0.598–2.579 | 0.561 |
Aspirin | 1.085 | 0.495–2.377 | 0.838 | |||
Statins | 1.230 | 0.562–2.695 | 0.605 | |||
β-Blockers | 0.756 | 0.237–2.410 | 0.637 | |||
ACEI/ARB | 0.813 | 0.199–3.323 | 0.773 | |||
CCB | 0.866 | 0.413–1.815 | 0.703 | |||
PCI | 0.614 | 0.280–1.345 | 0.223 | |||
Gensini group | ||||||
2nd tertile vs 1st tertile | 2.631 | 1.159–5.973 | 0.021 | 1.989 | 0.861–4.596 | 0.107 |
3rd tertile vs 1st tertile | 5.076 | 2.363–10.900 | < 0.001 | 3.216 | 1.458–7.093 | 0.004 |