Papel prognóstico da razão neutrófilos sobre linfócitos em pacientes com infarto agudo do miocárdio com supra desnivelamento do segmento-ST submetidos à estratégia fármaco-invasiva

• Ano de defesa: 2020
• Autor(a) principal: Tavares, Fernando Jose Soares [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Pharmaco-Invasive Strategy; Acute Myocardial Infarction; Neutrophil Ratio On Lymphocytes; Percutaneous Coronary Intervention; Inflammation; Estratégia Fármaco-Invasiva; Infarto Agudo Do Miocárdio; Relação Neutrófilo Sobre Linfócito; Intervenção Coronariana Percutânea; Inflamação
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=9923723; https://hdl.handle.net/11600/64623

Purpose: To determine the relationship between in-hospital mortality, major adverse cardiovascular events (MACE) and the neutrophil-limphocyte ratio (NLR) at hospital admission in patients with STEMI undergoing pharmacoinvasive strategy (PIS). Methods: Between March 2010 and October 2016, 1.860 STEMI patients treated with a pharmacoinvasive strategy and were consecutively included in this observational, single center, and retrospective study. The NLR was calculated as the ratio of neutrophil-to-lymphocyte count. The study population was divided into tertiles based on the NLR values at admission: low NLR: < 4.0, intermediate NLR: ≥ 4.0 and < 7.3, and upper NLR: ≥7.3. The primary endpoint was in-hospital mortality and secondary endpoint was MACE (cardiovascular death, non-fatal reinfarction, and stent thrombosis) in-hospital. Results: Patients with upper NLR experienced significantly higher in hospital mortality in comparison to patients with intermediate and low NLR values (9.0% vs. 4.8% vs. 1.8%, p<0.001). In-hospital MACE rate was also higher in patients with upper NLR (11.6% vs. 8.0% vs. 2.9%, p<0.001). Multivariable logistic regression analysis showed that upper NLR tercile was an independent predictor of in-hospital mortality [Odds ratio: 3.32, 95% confidence interval (CI): 1.19-9.28, p₌0.022]. The upper tertile value of the NRL was also an independent predictor of MACE [Odds ratio: 2.92, 95% confidence interval (CI): 1.43-5.97, p=0.003]. The best cutoff value of NRL to predict in-hospital mortality was 6.44 with an area under the curve of 0.692 (95% CI: 0.640 – 0.745) and for MACE was 6.15 with an area under the curve of 0.652 (95% CI: 0.607 – 0.697). Sensitivity and specificity for these cut offs were 63.9% and 60.2%, 61.4% and 58.4%, respectively. Conclusions: In this large-scale, observational study, involving patients with STEMI undergoing pharmacoinvasive strategy, values in the highest tertile of NLR during hospital admission were independent predictors of in-hospital death and MACE. RNL may be a simple and useful tool for stratification risk of mortality and recurrent ischemia in patients with STEMI undergoing pharmacoinvasive strategy.