Association between Neutrophil to Lymphocyte Ratio and Severity of Coronary Artery Disease in Chronic Stable Angina

Ratan Kumar Datta, Md Mamunur Rashid, MG Azam, Md Salahuddin Ulubbi, Mohammad Khalilur Rahman Siddiqui, Pranob Karmaker, Morshedul Ahsan, Jatindra Nath Saha, Muhammad Azmol Hossain, Abul Hasnat Md Jafar

Background: Neutrophil to lymphocyte ratio (NLR) has been proposed as a new prognostic marker in
patients with chronic stable angina (CSA). NLR is a cheap, easily available, non-invasive and routinely
done procedure to predict the severity of coronary artery disease.
Methods: 110 patients with stable coronary artery disease were evaluated to calculate the NLR from
January, 2016 to September, 2016. The patients were divided into two groups: Group I NLR>2.38 and
group II NLRd”2.38. Coronary angiogram was done during index hospitalization. The severity of the
coronary artery disease was assessed by vessel score and Gensini score and was compared between the
Results: NLR was significantly higher in the group of high vessel score and high Gensini score. We found
significant weak association between NLR and vessel score (r=0.30, p=0.004) and a moderate positive
correlation between NLR and Gensini score (r =0.65, P=0.001). With the increase of NLR, vessel score and
Gensini score increases demonstrating more severe coronary artery disease. Univariate logistic regression
analysis of variables of interest revealed that age, hypertension, dyslipidemia, serum creatinine, total
WBC count and NLR were independent predictor of severe coronary artery disease with odds ratio (OR)
being 1.88, 3.93, 5.01, 5.54, 4.05 and 5.70 respectively. In multivariate logistic regression analysis, after
adjustment of factors NLR remain independent predictors of severe CSA (OR = 5.73; p = 0.002).
Conclusion: Increased neutrophil to lymphocyte ratio is associated with angiographically severe coronary
artery disease in chronic stable angina and this association is independent of conventional cardiovascular
risk factors.