Incremental predictive value of the combined use of the neutrophil-to-lymphocyte ratio and systolic blood pressure difference after successful drug-eluting stent implantation

BACKGROUND: Previous work has highlighted the importance of the neutrophil-to-lymphocyte ratio (NLR) and the difference in the ward-to-catheterization laboratory systolic blood pressure (ΔSBP) in prognostic stratification after acute coronary syndrome. However, there is paucity of data regarding the added value of combining these two variables to predict 5-year major clinical outcomes after percutaneous coronary intervention. METHODS: A total of 1188 patients were classified into four groups according to the NLR and ΔSBP (high vs. low) using cutoffs derived from an analysis of receiver operating characteristic curves. A NLR > 3.0 and a ΔSBP > 25 mmHg were considered high values. The primary endpoint was the composite of all-cause death, cardiac death, and non-fatal myocardial infarction. The secondary endpoint was the composite of target lesion revascularization, target vessel revascularization, and incidence of cerebrovascular accidents. RESULTS: The incidence of the primary endpoint was significantly higher in the high NLR and ΔSBP group than in the other three groups (2.2% vs. 4.7% vs. 4.3% vs. 13.2%, p < 0.001). The incidence of the secondary endpoint was similar among the four groups. Incorporation of high NLR and high ΔSBP into a model with conventional and meaningful clinical and procedural risk factors increased the C-statistics in predicting the primary endpoint (0.575 to 0.635, p = 0.002). CONCLUSIONS: The power to predict the primary endpoint after drug-eluting stent implantation at the 5-year follow-up was improved by combining NLR and ΔSBP.