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Neutrophil/Lymphocyte Ratio in Patients Undergoing Noncardiac Surgery After Coronary Stent Implantation

Cited 5 time in Web of Science Cited 7 time in Scopus

Chung, Jaeyeon; Bae, Jinyoung; Kwon, Yongsuk; Yoon, Hyun-Kyu; Yoo, Seokha; Lee, Ho-Jim; Park, Sun-Kyung; Kim, Jin-Tae; Kim, Won Ho

Issue Date
W. B. Saunders Co., Ltd.
Journal of Cardiothoracic and Vascular Anesthesia, Vol.34 No.6, pp.1516-1525
© 2019 Elsevier Inc.Objective: Perioperative cell count–associated predictors, including the neutrophil/lymphocyte ratio (N/LR) and platelet/lymphocyte ratio (P/LR), are associated with poor clinical outcomes including myocardial injury. Study investigators aimed to examine the association among the perioperative N/LR, P/LR, and postoperative major adverse cardiovascular and cerebral events (MACCE) after noncardiac surgery in patients with drug-eluting stent (DES) insertion. Design: Retrospective and observational. Setting: Single university hospital. Participants: The study comprised 965 patients who underwent noncardiac surgery within 6 months after DES implantation. Interventions: None. Measurements and Main Results: Baseline perioperative clinical parameters, including N/LR and P/LR measured before surgery, immediately after surgery, and on postoperative day (POD) 1, were obtained. MACCE was defined as a composite of nonfatal myocardial infarction, coronary revascularization, nonhemorrhagic stroke, and pulmonary embolism within 1 month after surgery. Multivariate logistic regression analysis and propensity score matching were used to identify predictors of MACCE after surgery. MACCE occurred in 67 patients (6.9%) and was more common in patients with N/LR on POD 1 >4.3 (multivariable-adjusted odds ratio [OR] 2.03, 95% confidence interval [CI] 1.12-2.79; p = 0.040 and as a continuous N/LR [OR 1.17, 95% CI 1.08-1.27; p < 0.001]). This association was consistent after propensity score matching and was stronger when the antiplatelet agent was stopped before surgery (OR 3.02, 95% CI 2.14-4.48; p = 0.006 for stopping dual antiplatelet therapy). Conclusions: In patients undergoing noncardiac surgery within 6 months after DES implantation, elevated N/LR on POD 1 is independently associated with postoperative MACCE. Elevated postoperative N/LR as a marker of systemic inflammation may help to predict the development of MACCE in these high-risk patients.
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