The Prognostic Value of Total Neutrophil Count, Neutrophil/Lymphocyte Ratio and Left Ventricular Ejection Fraction in Predictingin-hospital Mortality and Complications after Acute STEMI: Prospective Investigation

Background: Leukocytosis predominantly neutrophilia has been described following ST elevation
myocardial infarction (STEMI). But its exact association with clinical outcome of STEMI is not well
studied. So hereby we examined the cellular inflammatory response to STEMI in the blood was
assessed by total neutrophil count (TNC), neutrophil to lymphocyte ratio (NLR) and Left ventricular
ejection fraction (LVEF) post myocardial infarction and their association with in-hospital mortality
and/or adverse clinical events.
Methods: 50 patients of acute STEMI were studied. In all the patients complete blood cell count
(CBC), total leukocyte count and differential leukocyte count were performed and
neutrophil/lymphocyte ratio (NLR) was calculated. Left ventricular ejection fraction was assessed
within one week of MI. Association of cellular response and ejection fraction with the incidence of
post-MI mortality/complicationswere assessed by using ROC curve analysis and chi square test.
Results: In-hospital mortality and post-STEMI complication rate were 8% and 42%, respectively.
Total neutrophil count and Neutrophil to lymphocyte ratio were predictors of mortality. High NLR and
lower LVEF were predictors of total complications and cardiogenic shock. Pump failure in the form of
acute pulmonary edema (6%) or cardiogenic shock (8%) occurred in 7 (14%) patients. Higher total
neutrophil counts, higher NLR and lower ejection fraction were predictors of pulmonary edema. The
frequency of ventricular tachyarrhythmias at the first day was associated with higher NLR level. High
TNC and low LVEF were predictors for first degree heart block and high NLR was predictor for third
degree heart bock and left bundle branch block.
Conclusion: A single CBC analysis along with routinely assessed parameter i.e. ejection fraction may
help to identify STEMI patients at risk for mortality and heart failure, and neutrophil to lymphocyte ratio
is the most valuable in predicting both.