Usefulness of Platelet-to-Lymphocyte Ratio to Predict Long-Term All-Cause Mortality in Patients at High Risk of Coronary Artery Disease Who Underwent Coronary Angiography

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Platelet-to-lymphocyte ratio (PLR) has recently been studied as a biomarker in patients with established coronary artery disease (CAD). The association between PLR and long-term all-cause mortality is unclear in patients at high risk of CAD who undergo coronary angiography for various indications. Follow-up was completed for 514 patients who underwent coronary angiography in a prospective study cohort. The primary end point was all-cause mortality. Patients were classified into tertiles based on preangiography PLR and also dichotomized based on the optimal cutoff at a PLR of 137, determined from the receiver operating characteristic curve analysis. The mean follow-up period was 5.0 ± 1.3 years, with 50 all-cause deaths. On the Kaplan-Meier analysis, patients in Tertile 3 (PLR > 145) had worse prognosis than patients in Tertiles 1 (PLR ≤ 106) and 2 (PLR 106.1 to 145) (p = 0.0075), and patients with PLR ≥ 137 had a significantly higher rate of all-cause mortality than those with PLR < 137 (p = 0.0006). On multivariate Cox regression adjusting for known cardiovascular risk factors, PLR was a strong, independent predictor of long-term all-cause mortality on the tertile analysis (Tertile 3 vs Tertile 1: hazard ratio 2.52, 95% confidence interval 1.18 to 5.39, p = 0.017) and based on the cutoff at a PLR of 137 (PLR ≥ 137 vs <137: hazard ratio 2.25, 95% confidence interval 1.21 to 4.20, p = 0.011). In conclusion, elevated PLR is associated with long-term all-cause mortality in patients at high risk of CAD who undergo coronary angiography, and PLR may be a useful prognostic biomarker in this population.

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Methods

The study population was identified from the Biomarkers of Atherosclerosis, Vascular and Endothelial Dysfunction in Heart Disease (BRAVEHEART) Study. The BRAVEHEART study is a prospective cohort study that consecutively recruited patients admitted to St Vincent's Hospital, Melbourne for coronary angiography and percutaneous coronary intervention (PCI) from October 2009 to May 2013, excluding patients with acute or chronic infections, systemic inflammatory conditions, recent or untreated

Results

A total of 514 patients were included in the study, of which 354 were male (69%) and 160 were female (31%), with mean ages of 63 ± 11 years and 65 ± 11 years, respectively. The mean follow-up period was 5.0 ± 1.3 years and there were 50 all-cause deaths. Table 1 lists the baseline clinical and biochemical characteristics of each of the 3 groups based on their preangiography PLR values (Tertile 1: PLR ≤ 106, Tertile 2: PLR 106.1 to 145, Tertile 3: PLR > 145). Patients in Tertile 3 were more

Discussion

In our study, we demonstrated that admission PLR was associated with long-term all-cause mortality in patients at high risk of CAD who underwent coronary angiography for various indications. Patients in the highest PLR tertile (Tertile 3) had a significantly higher rate of the primary end point compared with the lower 2 tertiles (Tertiles 1 and 2) and a similar trend was seen in the analysis based on the optimal cutoff at PLR of 137. In addition, we showed that PLR is a significant, independent

Disclosures

The authors have no conflicts of interest to disclose.

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Andrew M. Wilson is supported by grants from the National Heart Foundation of Australia, the Diabetes Australia Research Trust, and the Australian Catholic University (Melbourne, Victoria, Australia). Arul Baradi is supported by an Australian Government Research Training Program Scholarship and an NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement (CRE-COI) PhD Scholarship (Melbourne, Victoria, Australia).

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