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Abstract
Background The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with adverse cardiovascular outcomes. However, limited evidence exists regarding its prognostic role in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI), which we sought to explore in this analysis.
Methods We retrospectively evaluated all patients undergoing PCI at a large tertiary centre between 2012 and 2022. Patients were stratified according to the presence of DM, and NLR quartiles were derived in each subgroup. The primary endpoint was major adverse cardiovascular events (MACE), consisting of all-cause mortality, spontaneous myocardial infarction (MI) or stroke. Secondary endpoints were each single MACE component, target vessel revascularisation, bleeding and postprocedural acute kidney injury. A multivariable Cox regression model, adjusted for relevant baseline characteristics, was computed.
Results A total of 9427 patients were included (48.5% with DM). DM patients had more comorbidities and higher baseline high-sensitivity C reactive protein levels, while patients with elevated NLR in both subgroups exhibited multivessel disease with moderate/severe calcification. DM patients in the upper NLR quartile had the highest rates of MACE (15.7%) than any other subgroup. An independent association of elevated NLR with MACE was observed in both patients with and without DM, and was confirmed after multivariable adjustment. This was primarily driven by all-cause mortality rates in both subgroups and by MI incidence in DM patients only.
Conclusions Patients undergoing PCI with a higher NLR had worse clinical outcomes, regardless of DM status. The combination of DM and elevated NLR revealed the most unfavourable prognosis.
- Diabetes Mellitus
- Inflammation
- Percutaneous Coronary Intervention
- Biomarkers
Data availability statement
Data are available on reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.
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Data availability statement
Data are available on reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.
Footnotes
Presented at Part of this work was presented as a moderated poster at the most recent American Heart Association Scientific Sessions in 2024.
Contributors FMDM, BV, GD and RM conceptualised the manuscript. FMDM and SL wrote the original draft. SS and KS performed the statistical analyses. BB, AO, PK, MG, PM, JN, PMK and PPL visualised the manuscript. RM, GDD, BV, SKS, ASK and PPL revised the manuscript. All authors approved the final version of the manuscript. RM serves as the guarantor and is responsible for the overall content.
Funding BB is supported by a grant from the German Heart Foundation (grant number S/06/23).
Competing interests RM reports institutional research grants from Abbott Laboratories, Abiomed, Applied Therapeutics, AstraZeneca, Bayer, Beth Israel Deaconess, Bristol Myers Squibb, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Medtronic, Novartis Pharmaceuticals, OrbusNeich; consultant fees from Abbott Laboratories, Boston Scientific, Janssen Scientific Affairs, Medscape/WebMD, Medtelligence (Janssen Scientific Affairs), Novo Nordisk, Roivant Sciences, Sanofi, Siemens Medical Solutions; consultant fees paid to the institution from Abbott Laboratories, Bristol-Myers Squibb; advisory board, funding paid to the institution from Spectranetics/Philips/Volcano Corp; consultant (spouse) from Abiomed, The Medicines Company, Merck; Equity <1% from Claret Medical, Elixir Medical; DSMB Membership fees paid to the institution from Watermark Research Partners; consulting (no fee) from Idorsia Pharmaceuticals, Regeneron Pharmaceuticals. Associate Editor for ACC, AMA. Other authors declare no competing interests.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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