Intermediate-Risk Chronic Stable Angina: Neutrophil-Lymphocyte Ratio and Fibrinogen Levels Improved Predicting Angiographically-Detected Coronary Artery Disease
نویسندگان
1 Cardiovascular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
2 Cardiovascular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
3 HematologyWard, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
4 Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
5 Cardiovascular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
6 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
doi
چکیده
Background: Coronary heart disease (CHD) is the leading cause of death worldwide. Research indicates that coronary atherosclerosisis the most frequent cause of CHD. Evidence is scarce concerning the clinical efficacy of fibrinogen or neutrophil-lymphocyteratio (NLR) measurement in risk-stratifying patients with chronic stable angina.Objectives: To examine the independent and incremental prognostic value of fibrinogen and neutrophil-lymphocyte ratio (NLR)for angiographically-detected coronary artery disease (CAD).PatientsandMethods: In this cross-sectional study, angiography was performed for 183 Iranian patients with chronic stable anginawith exercise ECG-determined intermediate risk. Generalized estimated equations were used to obtain the odd ratio (OR) of CADfor a 1-unit increase in log-NLR and a 1-SD increase in plasma fibrinogen. Models were adjusted for established CAD risk factors.Integrated discriminatory improvement index (IDI) and net reclassification improvement index (NRI) were used as measures ofpredictive ability for CAD, combined with traditional risk factors by NLR and fibrinogen.Results: The mean age of the participants was 57.5, with 51.9% being male. Only 12% of participants had angiographicallydeterminedpatent coronary arteries. The numberof participants with one, two, and three-vessel stenosis were 76, 31, 31, respectively,while 45 did not have stenosed vessels. NLR and fibrinogen levels were significantly higher in patients with stenosis in two (2.4 and512 mg.dL-1) or three (2.6 and 517 mg.dL-1) coronary arteries, as compared to the group of patients with no significant involvement (2and 430 mg.dL-1) (all P < 0.01). Patients with a higher NLR and a higher fibrinogen levels were more likely to have higher grades ofCAD. OR log-NLR = 1.36 (95% CI: 1.05 - 1.94) and OR Z-Fibrinogen = 1.61 (95% CI: 1.18 - 2.22). When NLR and fibrinogen were added to thetraditional risk factors separately, the NRIs were 0.170 (0.023 - 0.324) and 0.380 (0.214 - 0.543), respectively. The NRI was 0.460 (0.303- 0.620) when both NLR and fibrinogen added to traditional risk factors simultaneously.Conclusions: NLR and fibrinogen predicted CAD, independent of traditional CAD risk factors. Both measures (whether separatelyor together) substantially enhanced the predictive performance of traditional risk factors for identifying patients with CAD.
