Platelet-To-Lymphocyte Ratio as a Predictor of No-Reflow after Primary Percutaneous Coronary Intervention in Patients with ST Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis

Document Type: Systematic review

Authors

1 Medical student, Mashhad University of Medical Sciences, Mashhad, Iran

2 Medical doctor, Mashhad University of Medical Sciences, Mashhad, Iran

3 Nuclear Medicine Specialist, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Cardiologist, Cardiology Department, Imam Reza Hospital, Mashhad University of Medical Sciences. Mashhad, Iran

Abstract

Introduction: No-reflow increases the complications and mortality rate of primary percutaneous coronary intervention (PCI). Therefore, it is important to identify patients at a higher risk of developing no-reflow. This study aimed to systematically review the prognostic value of the platelet-to-lymphocyte ratio (PLR) to predict no-reflow.
Materials and Methods: The databases, such as Pubmed, EMBASE, and Web of Knowledge were searched for the relevant studies. Two authors independently performed data extraction and quality assessment of the included studies. In this meta-analysis, sensitivity and specificity of PLR, as well as the pooled odds ratio were calculated to predict no-reflow and compared with the pooled means of PLR in no-reflow and reflow groups.
Results: According to the results obtained from six out of eight studies in this systematic review, there was a significant association between PLR and no-reflow. Moreover, a pooled six-fold increase of no-reflow risk was observed in the high PLR group. Pooled sensitivity and specificity of PLR to predict no-reflow was 65% (CI95%: 61%-69%) and 77% (CI95%: 76%-79%), respectively. The mean pooled of PLR in the no-reflow group was significantly 65.2 (CI95%: 26.7-103.8) units higher than that in the reflow group.
Conclusions: The PLR is a significant predictor of no-reflow in STEMI patients subjected to primary PCI which can be used alone or in combination with other markers to identify patients at higher risk of developing no-reflow.

Keywords


1.            Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135(10):e146-e603.

2.            Investigators G. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl j Med. 1993;1993(329):673-82.

3.            Van De Werf F, Adgey J, Ardissino D, Armstrong PW, Aylward P, Barbash G, et al. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet (London, England). 1999;354(9180):716-22.

4.            Cannon CP, Gibson CM, Lambrew CT, Shoultz DA, Levy D, French WJ, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA. 2000;283(22):2941-7.

5.            Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, et al. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med. 2002;346(13):957-66.

6.            Moosavi-Movahedi AA, Golchin AR, Nazari KK, Chamani J, Saboury AA, Bathaie SZ, et al. Microcalorimetry, energetics and binding studies of DNA–dimethyltin dichloride complexes. Thermochim Acta. 2004;414(2):233-41.

7.            Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, et al. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol. 2000;36(4):1202-9.

8.            Jaffe R, Dick A, Strauss BH. Prevention and treatment of microvascular obstruction-related myocardial injury and coronary no-reflow following percutaneous coronary intervention: a systematic approach. JACC Cardiovasc Interv. 2010;3(7):695-704.

9.            Ndrepepa G, Tiroch K, Keta D, Fusaro M, Seyfarth M, Pache J, et al. Predictive factors and impact of no reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction. Circ Cardiovasc Interv. 2010:CIRCINTERVENTIONS. 109.896225.

10.          Brosh D, Assali AR, Mager A, Porter A, Hasdai D, Teplitsky I, et al. Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality. The American journal of cardiology. 2007;99(4):442-5.

11.          Mueller H, Dyer A, Greenberg M. The thrombolysis in myocardial infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985;312(14):932-6.

12.          Mehta RH, Harjai KJ, Boura J, Cox D, Stone GW, O'Neill W, et al. Prognostic significance of transient no-reflow during primary percutaneous coronary intervention for ST-elevation acute myocardial infarction. Am J Cardiol. 2003;92(12):1445-7.

13.          Zolfagharzadeh M, Pirouzi M, Asoodeh A, Saberi MR, Chamani J. A comparison investigation of DNP-binding effects to HSA and HTF by spectroscopic and molecular modeling techniques. J Biomol Struct Dyn. 2014;32(12):1936-52.

14.          Schwartz BG, Kloner RA. Coronary no reflow. J Mol Cell Cardiol. 2012;52(4):873-82.

15.          Balta S, Demırkol S, Kucuk U. The platelet lymphocyte ratio may be useful inflammatory indicator in clinical practice. Hemodial Int. 2013;17(4):668-9.

16.          Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine. 2009;151(4):264-9, w64.

17.          Altman DG, McShane LM, Sauerbrei W, Taube SE. Reporting Recommendations for Tumor Marker Prognostic Studies (REMARK): Explanation and Elaboration. PLoS Med. 2012;9(5):e1001216.

18.          Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Research Methodology. 2014;14(1):135.

19.          Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006;6(1):31.

20.          Zhu W, Zeng N, Wang N. Sensitivity, specificity, accuracy, associated confidence interval and ROC analysis with practical SAS implementations.

21.          Kim KW, Lee J, Choi SH, Huh J, Park SH. Systematic Review and Meta-Analysis of Studies Evaluating Diagnostic Test Accuracy: A Practical Review for Clinical Researchers-Part I. General Guidance and Tips. Korean J Radiol. 2015;16(6):1175-87.

22.          Collaboration C. Cochrane handbook for systematic reviews of interventions version 5.1. 0. Higgins JPT, Green S (eds). 2011.

23.          Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine. 2009;6(7):e1000100.

24.          Amirpour A, Zavar R, Nejad AR. Association between the platelet-to-lymphocyte ratio and the no-reflow phenomenon and thrombolysis in myocardial infarction flow 3 after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Iranian Heart Journal. 2017;18(4):12-20.

25.          Ayça B, Akin F, Okuyan E. Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention. Platelets. 2015;26(8):816.

26.          Celık T, Balta S, Demır M, Osman Yıldırım A, Kaya MG, Ozturk C, et al. Predictive value of admission red cell distribution width-platelet ratio for no-reflow phenomenon in acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiology Journal. 2016;23(1):84-92.

27.          Kurtul A, Acikgoz SK. Usefulness of Mean Platelet Volume-to-Lymphocyte Ratio for Predicting Angiographic No-Reflow and Short-Term Prognosis After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2017;120(4):534-41.

28.          Kurtul A, Yarlioglues M, Murat SN, Ergun G, Duran M, Kasapkara HA, et al. Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute st-segment elevation myocardial infarction. Am J Cardiol. 2014;114(3):342-7.

29.          Toprak C, Tabakci MM, Simsek Z, Arslantas U, Durmus HI, Ocal L, et al. Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and long-term adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention. Postepy w Kardiologii Interwencyjnej. 2015;11(4):288-97.

30.          Wang Z, Ren L, Liu N, Peng J. Utility of Hematological Parameters in Predicting No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Clinical and Applied Thrombosis/Hemostasis. 2018;24(7):1177-83.

31.          Yildiz A, Yuksel M, Oylumlu M, Polat N, Akyuz A, Acet H, et al. The utility of the platelet-lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction. Clinical and Applied Thrombosis/Hemostasis. 2015;21(3):223-8.

32.          Berg R, Buhari C. Treating and Preventing No Reflow in the Cardiac Catheterization Laboratory. Curr Cardiol Rev. 2012;8(3):209-14.

33.          Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial No-Reflow in Humans. J Am Coll Cardiol. 2009;54(4):281-92.

34.          Chamani J, Heshmati M. Mechanism for stabilization of the molten globule state of papain by sodium n-alkyl sulfates: spectroscopic and calorimetric approaches. J Colloid Interf Sci. 2008;322(1):119-27.

35.          Li W, Liu Q, Tang Y. Platelet to lymphocyte ratio in the prediction of adverse outcomes after acute coronary syndrome: a meta-analysis. Sci Rep. 2017;7:40426.

36.          Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. New England Journal of Medicine. 2005;352(16):1685-95.

37.          Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Investig. 2005;115(12):3378.

38.          Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol. 2000;86(4):449-51.

39.          Sharif-Barfeh Z, Beigoli S, Marouzi S, Rad AS, Asoodeh A, Chamani J. Multi-spectroscopic and HPLC studies of the interaction between estradiol and cyclophosphamide with human serum albumin: binary and ternary systems. J Solution Chem. 2017;46(2):488-504.

40.          Tanboga IH, Topcu S, Aksakal E, Kalkan K, Sevimli S, Acikel M. Determinants of angiographic thrombus burden in patients with ST-segment elevation myocardial infarction. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2014;20(7):716-22.

41.          Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339.