Association Between Leukocytes: Absolute and Differential Ratios with Major Adverse Cardiac Cerebrovascular Events in ST-Elevation Myocardial Infarction Patients: Egyptian PCI-Capable Center Experience

Background: Previous studies have shown that inflammation and immune cells play a critical role in the onset, development, and prognosis of the patients with acute ST-elevation myocardial infarction (STEMI). Aim of the work: To evaluate the association between total leukocytic count (TLC) and neutrophil to lymphocyte ratio (NLR) and in-hospital major adverse cardiac cerebrovascular events (MACCE) in patients with STEMI. Patients and methods: A retrospective observational study was conducted on 607 STEMI patients. Routine laboratory tests included a complete blood picture on admission and 1 day later to calculate NLR (dividing neutrophil by lymphocyte counts) and TLC. Inflammatory markers (hsCRP) were measured. MACCE, No-reflow, and contrast-induced nephropathy (CIN) were recorded. The complicated in-hospital course was defined as those patients who necessitated supportive specific intensive care unit measures. Results: The mean age was 57.7 +/- 11.3 (488 male patients). The length of hospital stay was 6.5 +/- 5.0 days. Death (11%), target vessel revascularization was 0.8%, myocardial infarction was 0.8%, and stroke was 1%. Organ support measures were hemodynamic support (15.7%), respiratory support (7.4%), and renal replacement therapy (0.3%). Multivariate regression showed potential predictors of MACCE. Inflammatory markers (TLC first 24 hours and hsCRP), CIN, No-reflow phenomenon, and need for organ support measures were potential significant predictors. Repeated ANOVA showed that patients who did not develop MACCE showed a decrementing pattern. Non-survivors showed persistently non-decrementing TLC and NLR patterns. hsCRP cutoff (32.0) showed an area under the curve of 0.684, sensitivity of 70.9%, and specificity of 53.3%. TLC cutoff (11.0 x 10(3) mm(-3)) showed an area under the curve (AUC) of 0.769, sensitivity of 70.9%, and specificity of 65.7%. Conclusion: Total and differential leucocytic count ratio during the first 24 hours of admission could provide prognostic information for STEMI patients.