An investigation of syntax II score and neutrophil / lymphoside relationship in non-ST myocardial infarction

Objective: Coronary artery disease (CAD) is the leading cause of death in our country and the world. Myocardial infarction without ST-segment elevation (NSTEMI) is characterized by an increase in biological markers without ST-segment elevation. Based on coronary angiography; SYNTAX score, which is an anatomical scoring system, is used to determine the complexity, morphology, and extent of lesions according to their location in the coronary artery system. Six clinical variables (age, gender, ejection fraction (EF), creatine clearance, chronic obstructive pulmonary disease (COPD), and peripheral artery disease (PAD) are added to the SYNTAX score for calculating the SYNTAX II score. The neutrophil to lymphocyte ratio (NLR) is an independent risk factor for the acute coronary syndrome (ACS) and stable CAD and associated with the prevalence of atherosclerosis. The purpose of this study is to show the NLR ratio as a parameter of the prevalence of an inflammatory process, atherosclerosis, in clinical practice. Materials and Methods: The study was performed between January 2018 and January 2019, and 100 patients were included in the study according to the European Society of Cardiology 2015 non-ST segment elevated myocardial infarction guideline, who applied to the cardiology clinic of Adıyaman University. The severity, extent, and clinical evaluation of atherosclerosis have been performed with SYNTAX and SYNTAX II. The patients were divided into two groups as low SYNTAX II (n: 59) and high SYNTAX II (n: 41) according to the SYNTAX II score. Our study was designed as a single-center, retrospectively. NLR ratio was compared between the two groups. Results: 100 patients were included in the study and divided into group 1 and group 2 according to syntax score. Group 1 (Syntax II <23) comprised 59 patients, while group 2 (Syntax II> 32) comprised 41 patients. The average age of Group 1 was 72.2 ± 7.2, and the average age of Group 2 was 75.0 ± 8.3. The rate of male patients in group 1 is 29 (49.2%), and the rate of male patients in group 2 was 19 (46.3). Syntax score, Syntax II, total cholesterol, white blood cell count, neutrophil, lymphocyte, and NLR values showed a statistically significant difference in group 2 compared to group 1 (p <0.05). In logistic regression analysis, Syntax II and NLR were determined as multivariate independent predictors of NSTEMI (Relative risk (OR): 2.150; 95% confidence interval (CI): 1.539– 3.272; p = 0.001, OR: 1.836; 95% CI: 0.888–2.324; p = 0.005). Conclusion: The plasma NLR ratio was found statistically significantly higher in the patient group with a high syntax score compared to the group with a low syntax score. SYNTAX -II has a distinct advantage over anatomical SYNTAX, and in our study, high NLR levels were in parallel with high SYNTAX -II score. As a result, NLR levels are predictive of the prevalence and severity of coronary artery disease. Keywords: Acute coronary syndrome, Ejection fraction, Chronic obstructive pulmonary disease, Neutrophil/lymphocyte ratio, Peripheral artery disease, Myocardial infarction without ST-segment elevation, Syntax Score