Neutrophil to Lymphocyte Ratio and the Extent of Coronary Artery Disease: Results from a Large Cohort Study

The neutrophil to lymphocyte ratio (NLR), an inflammatory biomarker, may be of predictive and prognostic value for cardi-
ovascular (CV) events. We evaluated the relationship of NLR with the prevalence and extent of coronary artery disease (CAD)
in consecutive patients undergoing elective or urgent coronary angiography. Our population (n ¼ 3738 patients) was divided
into NLR quartiles. Higher NLR was associated with aging and established CV risk factors, previous percutaneous coronary
revascularization, acute presentation, and more complex pharmacological therapy. The NLR was related to platelet count,
white blood cell count, creatinine, glycemia, uric acid, and C-reactive protein (all P ¼ .001) levels but inversely related to
hemoglobin (P < .001), total cholesterol (P ¼ .005), and triglycerides (P < .001) levels. The NLR was associated with multivessel
disease (P < .001), anterior descending, right coronary arteries (P < .001) or circumflex branch lesions (P ¼ .01), percentage of
stenosis (P < .001), coronary calcification (P < .001), and intracoronary thrombus (P < .001) but inversely with in-stent
restenosis (P < .001) and thrombolysis in myocardial infarction flow (P ¼ .04). The NLR was directly related to the pre-
valence of CAD (P ¼ .001) and severe CAD (P < .001). In patients undergoing coronary angiography, the NLR is independently
associated with the prevalence and severity of CAD.