Impact of neutrophil-to-lymphocyte ratio on ischemic and bleeding outcomes in high-bleeding risk patients undergoing PCI

Abstract Background The neutrophil-to-lymphocyte ratio (NLR) may reflect systemic inflammation. The relationship between NLR and ischemic/bleeding outcomes among high-bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) is not well understood. Methods We included patients who underwent PCI at a tertiary-care center from 2012 till 2022. High NLR (hNLR) vs. low NLR (lNLR) was defined as >75th vs. ≤75th NLR percentile, respectively. HBR was defined per the Academic Research Consortium (ARC) HBR criteria. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction, or stroke at 1 year. All-bleeding was assessed as a secondary outcome. Results Out of 7,287 patients, 45.8% (n=3,334) were classified as HBR of whom 32.3% (n=1,077) had hNLR. In contrast, 18.7% (n=738) of non-HBR patients (n=3,953) had hNLR. The risk for MACE was higher in patients with hNLR in both HBR (aHR: 1.30; 95% CI: 1.01-1.67) and non-HBR (aHR: 1.80; 95% CI: 1.20-2.71) patients (Pint = 0.19) (Figure 1). Bleeding events rates in patients with hNLR, irrespective of HBR status, were higher than the 4% cutoff set by the ARC-HBR initiative (Figure 2). Furthermore, hNLR predicted the occurrence of bleeding in both the HBR (aHR: 1.51; 95% CI: 1.18-1.95) and non-HBR (aHR: 1.66; 95% CI: 1.17-2.36) groups (Pint = 0.42). Conclusion A hNLR is associated with a higher risk for ischemic/bleeding events in both HBR and non-HBR patients. Whether hNLR should be an ARC-HBR criterion is yet to be explored.Figure 1 Figure 2