Arivumalar, C (2018) A case control study of association of neutrophil to lymphocyte ratio and heart failure in patients with acute ST- Elevation myocardial infarction. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Ischemic heart disease (IHD) is a condition in which there is an inadequate supply of blood and oxygen to the myocardium; typically occurring when there is an imbalance between myocardial oxygen supply and demand. Atherosclerotic disease of an epicardial coronary artery (or arteries) sufficient to cause a regional fall in myocardial blood flow and inadequate perfusion of the myocardium supplied by the involved coronary artery is the most common cause of myocardial ischemia. A substantial percentage of patients will progress to myocardial infarction. Coronary artery Heart Disease (CHD) is a leading cause of mortality and morbidity worldwide. The mortality and morbidity is attributed to the development of heart failure and cardiogenic shock in a considerable number of cases. Inflammation is a component of various disorders of the human body triggered by varying etiologies. Myocardial infarction is not an exception to this. Though the triggering event is an occlusion of the coronary artery, various studies have proved an inflammatory component in the pathogenesis. Neutrophil lymphocyte ratio (NLR) is one among the markers for ongoing systemic inflammatory response. In our study we aim to see whether there is an association between elevated on admission NLR and occurrence of heart failure in patients with ST-elevation myocardial infarction (STEMI). This is a case control study design with patients having acute STEMI and developing heart failure taken as the test group and those without heart failure taken as the control group. The number of patients with an elevated NLR (>3.5) is recorded in each group and statistical analysis is used to look for any statistically significant difference between the two groups. This will help us for additional risk stratification of the patients with acute STEMI. AIMS & OBJECTIVES: To investigate the association between on admission NLR and heart failure in acute ST elevation myocardial infarction. MATERIALS AND METHODS: In my study a secondary data analysis of case sheets was done. On admission NLR (normal NLR is 1.8-3.5) is calculated from complete blood count taken within one hour of admission in patients with and without heart failure getting admitted to the intensive coronary care unit with acute ST- elevation myocardial infarction taking a sample size of 55 in each group. ST elevation MI is defined as > 0.2mV in V2 – V3, > 0.1 mV in all other leads. A comparison of NLR will be made between those with and without heart failure. This study will help us to know the association of NLR and occurrence of heart failure in those with acute ST elevation myocardial infarction. This will help us for additional risk stratification of the patients with acute STEMI. 110 cases of acute STEMI (55 with heart failure and 55 without heart failure) are required to identify the association between elevated NLR and heart failure in acute STEMI at 95% confidence interval and when the percentage of acute STEMI without heart failure with elevated NLR is 46% and the difference between the two is 30%. At KMC on an average 4 cases of AMI per day gets admitted with 40% developing heart failure. To get 55 cases of heart failure it would require roughly 2 months. RESULTS: Among the entire sample 79 were males and 31 were females. In our study we encountered an increased frequency of acute STEMI in the male population. The mean age of the patients among the cases is 53.65+/- 6.43. The mean age of the patients among the control group is 51.2+/- 6.59. The results of the unpaired t-test for neutrophil count between the two groups shows high statistical significance with a P value of 0.0005. The lymphocte count between the two groups did not reach statistical significance in the unpaired t-test. The NLR distribution between the two groups is highly statistically significant with a P value of 0.0005. done a Pearsons Chi-Square test on categorical data by dividing patients with NLR <3.5 and those with NLR >/= 3.5 between the cases and controls. This achieved high statistical significance with a P value of 0.0005. CONCLUSIONS: This study demonstrates that a high NLR value is associated the increased risk of heart failure in acute ST elevation MI. NLR more than or equal to 3.5 predicted heart failure in those patients. Thus NLR, which is easy to assess and inexpensive, may be a novel biomarker for assessing inflammation and identifying high risk for heart failure in acute ST elevation MI. NLR was inversely correlated with EF and is an independent predictor of heart failure in acute STEMI.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Heart failure ; Neutrophil lymphocyte ratio ; Acute coronary syndrome ; Myocardial infarction. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 27 Aug 2018 16:55 |
| Last Modified: | 27 Aug 2018 16:55 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/9379 |
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