Prognostic Value of Neutrophil-to-lymphocyte Ratio for Patients with Acute Coronary Syndrome and Obstructive Sleep Apnea

Objective: This study was aimed at investigating the effects of the neutrophil-to-lymphocyte ratio (NLR) on the longterm prognosis of patients with acute coronary syndrome (ACS) and obstructive sleep apnea (OSA). Methods: This prospective study enrolled patients with ACS and OSA at Anzhen Hospital between June 2015 and January 2020. OSA was defined by an apnea-hypopnea index >= 15 events center dot h(-1). Baseline NLR was classified as high or low, according to the median. The primary endpoint was major adverse cardiovascular events (MACE), comprising cardiovascular death, recurrent myocardial infarction, stroke, and ischemia-driven revascularization. Results: A total of 1011 patients with ACS and OSA were enrolled, 506 of whom were in the high NLR (>= 2.54) group. No significant differences in sleep monitoring indicators were observed. During a median follow-up of 2.8 (1.4, 3.6) years, a non -linear correlation between NLR and the incident risk of MACE was observed. After adjustment for clinically relevant confounders, a high NLR was independently associated with elevated MACE risk (adjusted HR = 1.45, 95% CI: 1.02-2.06, P = 0.040). Conclusions: In patients with ACS and OSA, a high NLR was associated with poorer clinical outcomes during longterm follow-up.