Review Article

The Role of Hematological Indices in Patients with Acute Coronary Syndrome

Table 1

Summary of some studies investigating diagnostic and prognostic role of the most important hematological indices.

Study typeStudySample sizeMain findingsReferences

WBC
RetrospectiveCannon et al. (2001)7651 patients with ACSWBC count of >10,000 was associated with increased 30-day and 10-month mortality.[9]
RetrospectiveBarron et al. (2000)975 patients with MIElevation in WBC count was associated with reduced epicardial blood flow and myocardial perfusion, thromboresistance, and a higher incidence of new congestive heart failure and death.[10]
ProspectiveSabatine et al. (2002)2220 patients with UA/NSTEMIHigher baseline WBC count was associated with impaired epicardial and myocardial perfusion, more extensive CAD, and higher six-month mortality rates.[8]
RetrospectiveGurm et al. (2003)4450 patientsA low or an elevated preprocedural WBC count in patients undergoing PCI is associated with an increased risk of long-term death.[11]
ProspectiveChia et al. (2009)363 patients with STEMIElevated leucocyte and neutrophils are predictors of adverse cardiac events.[12]
NLR
ProspectiveDuffy et al. (2006)1046 patients who underwent PCIThe NLR was an independent significant predictor of long-term mortality in patients who have undergone coronary angiography.[18]
ProspectiveTamhane et al. (2008)2833 patients with ACSNLR was a predictor of in-hospital and 6-month mortality in patients who undergo PCI.[21]
ProspectiveNúñez et al. (2008)515 patients with STEMINLR was a useful marker to predict subsequent mortality in patients admitted for STEMI, with a superior discriminative ability than total WBC.[22]
ProspectiveAzab et al. (2010)1345 patients with NSTEMINLR is an independent predictor of short-term and long-term mortalities in patients with NSTEMI.[26]
RetrospectiveChatterjee et al. (2011)30,798 records who have undergone coronary angiographyA preprocedural NLR, elevated WBC count, and neutrophils were predictors of significant ventricular arrhythmias in patients undergoing PCI.[27]
ProspectiveAkpek et al. (2012)418 patients with STEMI who underwent PCIThe NLR was independently associated with the development of no-reflow and in-hospital MACEs in patients with ST-segment elevation myocardial infarction undergoing primary PCI.[23]
ProspectiveSahin et al. (2013)840 patients with STEMI who underwent PCINLR was the independent predictor for SYNTAX score in patients with STEMI.[24]
RetrospectiveSawant et al. (2014)250 consecutive STEMI patientsNLR based on an optimal cut-off value of 7.4 was an excellent predictor of short- and long-term survival in patients with revascularized STEMI.[31]
RetrospectiveAyça et al. (2015)102 patients with stent tshrombosis and 450 patients with STEMIIn patients with STEMI, preprocedural high NLR was associated with both stent thrombosis and higher mortality rates.[28]
ProspectiveYaylak et al. (2016)A total of 213 subjects with inferior STEMINLR was an independent predictor of RVD in patients with inferior STEMI undergoing primary PCI.[25]
RDW
RetrospectiveNabais et al. (2009)1796 patients with ACSThere is a graded independent association between higher RDW values and adverse outcomes in patients with ACS.[45]
ProspectiveLippi et al. (2009)456 patients with ACSRDW at admission might be considered with other conventional cardiac markers for the risk stratification of ACS patients admitted to emergency departments.[48]
ProspectiveDabbah et al. (2010)1709 patients with AMIRDW is a predictor of mortality after AMI. Moreover, an increase in RDW during hospitalization also portends adverse clinical outcome.[44]
RetrospectiveUyarel et al. (2011)2506 STEMI patientsRDW at admission was a predictor of in-hospital and long-term cardiovascular mortality.[46]
ProspectiveIsik et al. (2012)135 patients with STEMIRDW is a marker indicating long-term prognosis.[47]
ProspectiveTimóteo et al. (2015)787 patients with ACSCombination of RDW with GRACE score improves the predictive value for all-cause mortality.[80]
PLR
Observational studyAzab et al. (2012)619 patients with NSTEMIPLR is a significant independent predictor of long-term mortality after NSTEMI.[56]
ProspectiveKurtul et al. (2014)1016 patients with ACSPLR at admission is significantly associated with the severity and complexity of coronary atherosclerosis in patients with ACS.
Increased PLR is an independent predictor of higher SYNTAX score in patients with ACS who undergo urgent CA.
[82]
RetrospectiveAcet et al. (2016)800 patients with STEMIPLR, RDW and monocyte were associated with GRACE score in patients with STEMI.[81]
RetrospectiveYildiz et al. (2015)287 patients with STEMIHigh preprocedural PLR and NLR levels are significant and independent predictors of no-reflow in patients undergoing primary PCI.[58]
ProspectiveSun et al. (2017)5886 patients with STEMIHigher PLR was associated with recurrent myocardial infarction, heart failure, ischemic stroke, and all-cause mortality in patients with STEMI.[57]
ProspectiveVakili et al. (2017)215 patients with STEMIPLR and NLR were associated with no-reflow phenomenon in patients with STEMI treated with pPCI.[59]
PDW
ProspectiveDe Luca et al. (2010)1882 patients undergoing coronary angiography + IMT in 359 patientsPDW is not related to the extent of CAD and carotid IMT. PDW positively correlated with age, weight, waist circumference, and prevalence of diabetes.[78]
ProspectiveRechciński et al. (2013)538 patients who underwent primary PCI in acute MIPDW and P-LCR are prognostic predictors after MI.[63]
RetrospectiveCelik et al. (2015)306 patients with STEMIBaseline PDW and MPV are independent correlates of no-reflow and in-hospital MACEs among patients with STEMI undergoing pPCI.[64]
RetrospectiveBekler et al. (2015)502 patients with ACS were enrolled.The group with PDW > 17% had significantly higher Gensini score.[61]
MPV
ProspectiveHuczek et al. (2005)398 patients with STEMIMPV is a predictor of impaired reperfusion and mortality in STEMI treated with pPCI.[65]
Case-control studyHuczek et al. (2010)36 consecutive ST cases and 72 matched controlsBaseline platelet size is increased in patients with ACS developing early stent thrombosis and correlates with future residual platelet reactivity.[70]
Systematic review + meta-analisisChu et al. 2010Pooled results from 16 cross-sectional studies involving 2809 patients with CADElevated MPV is associated with AMI, mortality following myocardial infarction, and restenosis following coronary angioplasty.[69]
RetrospectiveIsik et al. (2012)2467 who underwent coronarography with CADDiabetes, smoking, hemoglobin, and MPV were found to be the independent correlates of SCF presence. Moreover, only MPV was identified as an independent correlate of extent of SCF.[73]
ProspectiveWan et al. (2014)297 ACS patientsBoth MPV and the GRACE score were significant and independent predictors for CVD events.
Combination of MPV with the scoring system improved the predictive value.
[83]
ProspectiveNiu et al. (2015)506 ACS patientsElevated MPV was an independent predictor of 6-month mortality or MI in patients with ACS.
The addition of MPV to the GRACE model improved its predictive value.
[84]

ACS: acute coronary syndrome; AMI: acute myocardial infarction; NSTEMI: non-ST elevation myocardial infarction; MI: myocardial infarction; MPV: mean platelet volume; STEMI: ST elevation myocardial infarction; CAD: coronary artery disease; TIMI: thrombolysis in myocardial infarction; WBC: white blood cell count; RDW: red blood cell distribution width; PDW: platelet distribution width; PLR: platelet lymphocyte ratio; P-LCR: platelet large cell ratio; CVD: cardiovascular disease; HF: heart failure; PCI: percutaneous coronary intervention; RVD: right ventricular dysfunction; MACEs: major adverse cardiac events; GRACE: global registry of acute coronary events; SCF: slow coronary flow; IMT: intima media thickness.