Impact of Neutrophil-Lymphocyte Ratio on Long-term Outcomes of Patients with Coronary Chronic Total Occlusion After Percutaneous Coronary Intervention

Abstract Background: The impact of preprocedural neutrophil-lymphocyte ratio (NLR) level on subsequent adverse cardiovascular events and health status in coronary chronic total occlusion (CTO) patients after stent implantation is unclear. The present study aims to evaluate the impact of NLR level on long-term clinical outcomes and health status of CTO patients after percutaneous coronary intervention (PCI) in the drug eluting stent era. Methods: A total of 311 CTO patients who underwent successful PCI with new-generation drug-eluting stent and with follow-up were enrolled. Patients were classified into 3 groups according to the tertiles of NLR level at baseline. The primary endpoint (major adverse cardiac events, MACE) was a composite of cardiac death, target-vessel myocardial infarction (MI), and ischemia-driven target-vessel revascularization (TVR) on follow-up. Multivariable COX regression analysis was performed to estimate the relationships between the parameters and MACE. Results: Compared with the low and intermediate tertile groups, preprocedural platelet-lymphocyte ratio (PLR) level and age were significantly higher in the high NLR tertile group. After a median follow-up of 32 (interquartile range: 20 to 44) months, MACE was observed in 10 patients (9.7%) in the low tertile, in 21 (20.2%) in the intermediate tertile, and in 31 (29.8%) in the high tertile group ( P = 0.001). Kaplan-Meier analysis demonstrated a significantly higher incidence of MACE, mainly driven by TVR, in patients with high tertile than the low and intermediate tertile groups. Multivariable COX regression analysis showed NLR and occluded length as independent predictors of MACE. No statistically differences were observed regarding the five domains of Seattle Angina Questionnaire (SAQ) scores among the 3 groups (all P > 0.05). Conclusions: In conclusion, in patients who underwent PCI for CTO lesions, elevated NLR level was independently associated with MACE (driven by TVR) on follow-up.