Use of the neutrophil to lymphocyte ratio for prediction of in-stent restenosis in bifurcation lesions

Abstract

OBJECTIVE: Percutaneous coronary interventions (PCI) are the preferred treatment for coronary artery disease, even though the development of in-stent restenosis (ISR) continues to be an important complication. Neutrophil to lymphocyte ratio (NLR) is indicative of the inflammatory process and can predict the short- and long-term prognosis of cardiovascular diseases. We investigated the relationship between ISR development and neutrophil-lymphocyte ratio (NLR) in bifurcation lesions in stable coronary artery disease (CAD) patients.

PATIENTS AND METHODS: We analyzed the clinical and angiographic data of 181 consecutive stable CAD patients who had undergone successful PCI to the true bifurcation lesion from January 2010-December 2012. Patients were divided into two groups based on the development of ISR (group 1, ISR -; group 2, ISR +).

RESULTS: NLRafter (p < 0.001) and NLR Delta (p < 0.001) were significantly higher in group 2. NLR Delta was found to be significant independent predictor of ISR in the multivariate logistic regression analysis. A NLR Delta level > 0.58 mg/dL had 81.8% sensitivity and 93.5% specificity for the prediction of ISR, as identified by the ROC curve. A NLRafter level > 3.43 predicted ISR with 45.5% sensitivity and 95.8% specificity. The comparison of ROC curve analysis demonstrated that NLR Delta was the strongest independent predictor of ISR (p = 0.001).

CONCLUSIONS: As a result, although drug eluting stent implantation is known to be recommended in the bifurcation lesion PCI in worldwide, we want to emphasize the usage of the NLR values in the prediction of ISR. So, we think that NLR Delta levels may be a useful marker for the prediction of ISR in patients who undergo bifurcation PCI.