Suilbert Rodríguez-Blanco, Departamento de Hemodinámica y Cardiología Intervencionista, Hospital Hermanos Ameijeiras, La Habana, Cuba
Orlando Henríquez-Italin, Departamento de Arritmias y Marcapasos, Hospital Hermanos Ameijeiras, La Habana, Cuba
Andrew S. Dzebu, Departamento de Hemodinámica y Cardiología Intervencionista, Hospital Hermanos Ameijeiras, La Habana, Cuba
José M. Aguilar-Medina, Departamento de Hemodinámica y Cardiología Intervencionista, Hospital Hermanos Ameijeiras, La Habana, Cuba
Enmanuel Hernández-Valdés, Departamento de Hemodinámica y Cardiología Intervencionista, Hospital Hermanos Ameijeiras, La Habana, Cuba
Lázara M. Pérez-Yánez, Departamento de Hemodinámica y Cardiología Intervencionista, Hospital Hermanos Ameijeiras, La Habana, Cuba
Introduction: Type 4a myocardial infarction (MI) is a complication of percutaneous coronary intervention (PCI) associated with increased inflammatory response and adverse clinical outcomes. The aim was to identify demographic, clinical, anatomical, procedural, and inflammatory variables associated with type 4a MI, and to assess the diagnostic and prognostic value of the neutrophil-to-lymphocyte ratio (NLR). Method: We conducted a prospective cohort study in the department of hemodynamics and interventional cardiology at the Hospital Clínico Quirúrgico Hermanos Ameijeiras, between November 2018 and January 2020. A total of 184 consecutive patients were included. Results: Type 4a MI occurred in 25 patients (13.5%). In multivariate analysis, left ventricular systolic function, presence of bifurcation lesions, and NLR variation were independently associated with this complication. For prediction, a pre-procedural NLR ≥ 2.74 yielded an area under the ROC curve of 0.751, with 72.0% sensitivity, 74.8% specificity, and a high negative predictive value. For diagnosis, an NLR ≥ 2.63 at 6 hours after PCI achieved an area under the ROC curve of 0.932, with 84.0% sensitivity, 74.2% specificity, and a very high negative predictive value. Conclusions: Left ventricular systolic function, bifurcation lesions, and NLR variation were independently associated with type 4a MI. The NLR proved to be a sensitive and specific biomarker with a high negative predictive value for both prediction and diagnosis of type 4a MI. Its use may contribute to risk stratification and early clinical decision-making in patients undergoing PCI.
Keywords: Neutrophil-to-lymphocyte ratio. Type 4a myocardial infarction. Coronary intervention.