Cayli, Murat

Yildiz, Abdulkadir

Yuksel, Murat

English

Via Medica Journals

The prognostic value of white blood cell  count-to-mean platelet volume ratio  in patients with acute coronary syndromeWe have read the article entitled “White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome” [1] with great interest. Both leukocytes and platelets have been reported to be involved in several cardiovascular (CV) diseases through inflammatory pathways. The close rela-tionship between inflammation, aggregation, and atherosclerosis progression has become a field of intensive research. The study by Dehghani et al. [1] evaluated the predictive role of white blood cell count/mean platelet volume (WBC/MPV) ratio (WMR) in long-term outcomes of acute coronary syndrome (ACS) patients. However, we have some comments regarding the presented study.Previous studies revealed an association be-tween higher rates of major adverse cardiac events and poorer outcomes with both higher platelet and lower lymphocyte counts [2–4]. The advantage of the platelet-to-lymphocyte ratio (PLR) is that it reflects both hyperactive aggregation and inflam-matory pathways, and it may be superior to either the individual platelet or the lymphocyte counts in the prediction of long-term outcome in CV diseases. Azab et al. [5] showed that higher PLR values are associated with higher long-term mor-tality in patients presenting with non-ST segment elevation ACS.  Several additional studies have appeared recently, that integrate the predictive risk of this novel marker, PLR, in ACS settings [6–9]. As increased platelet count and decreased lympho-cyte levels are associated with poor CV outcome, it is logical to integrate these 2 parameters into 1. White blood cell count and its differential, C-reactive protein and the neutrophil-to-lymphocyte ratio are some of the inflammatory markers that were demonstrated to have predictive and prog-nostic significance in a wide range of CV diseases including ACS [10–12]. On the other hand, MPV is another recent hematologic parameter being extensively investigated. A number of studies have demonstrated that higher MPV values are associ-ated with poorer long-term outcome in patients presented with ACS [13–15]. Therefore, increased levels of both WBC and MPV levels were shown to be associated with adverse CV outcomes; the proposed novel marker, WMR, would most likely blunt the predictive power of these parameters, as a result of dividing WBC by MPV.Conflict of interest: None declaredReferences1.  Dehghani MR, Rezaei Y, Taghipour-Sani L. White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome. Cardiol J, 2015; doi: 10.5603/ /CJ.a2015.0015 [Epub ahead of print].2.  Nikolsky E, Grines CL, Cox DA et al. Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). Am J Cardiol, 2007; 99: 1055–1061.3.  Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CG, Thomson SP, Gibbons RJ. Predictive power of the relative lymphocyte con-centration in patients with advanced heart failure. Circulation, 1998; 97: 19–22.4.  Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lym-phocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol, 2000; 86: 449–451.5.  Azab B, Shah N, Akerman M, McGinn JT, Jr. Value of platelet/ /lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thrombosis Thrombolysis, 2012; 34: 326–334.6.  Yildiz A, Yuksel M, Oylumlu M et al. The utility of the plate-let-lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction. Clinical Applied Thrombosis/Hemostasis, 2015; 21: 223–228.7.  Acet H, Ertas F, Akil MA et al. Novel predictors of infarct-related artery patency for ST-segment elevation myocardial in-farction: Platelet-to-lymphocyte ratio, uric acid, and neutrophil-to-lymphocyte ratio. Anatolian J Cardiol, 2014; doi: 10.5152/ /akd.2014.5592 [Epub ahead of print].8.  Oylumlu M, Yildiz A, Oylumlu M et al. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anatolian J Cardiol, 2015; 15: 277–283.9.  Acet H, Ertas F, Akil MA et al. Relationship between hematologic indices and global registry of acute coronary events risk score in patients with ST-segment elevation myocardial infarction. Clin App Thromb Hemost, 2014; May 8 [Epub ahead of print].351www.cardiologyjournal.orgLETTER TO THE EDITORCardiology Journal 2015, Vol. 22, No. 3, 351–352DOI: 10.5603/CJ.2015.0029Copyright © 2015 Via MedicaISSN 1897–559310.  Celik T, Iyisoy A, Yuksel UC, Jata B, Ozkan M. The impact of admission C-reactive protein levels on the development of no-reflow phenomenon after primary PCI in patients with acute myocardial infarction: The role of inflammation. Int J Cardiol, 2009; 136: 86–88; author reply: 88–89.11.  Sen N, Afsar B, Ozcan F et al. The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarc-tion undergoing primary coronary intervention. Atherosclerosis, 2013; 228: 203–210.12.  Hartaigh B, Bosch JA, Thomas GN et al. Which leukocyte sub-sets predict cardiovascular mortality? From the LUdwigshafen RIsk and Cardiovascular Health (LURIC) Study. Atherosclerosis, 2012; 224: 161–169.13.  Wan ZF, Zhou D, Xue JH et al. Combination of mean platelet volume and the GRACE risk score better predicts future car-diovascular events in patients with acute coronary syndrome. Platelets, 2014; 25: 447–451.14.  Niu X, Yang C, Zhang Y, Zhang H, Yao Y. Mean platelet volume on admission improves risk prediction in patients with acute coronary syndromes. Angiology, 2015; 66: 456–463.15.  Ozlu MF, Ozturk S, Ayhan SS et al. Predictive value of mean platelet volume in young patients with non-ST-segment eleva-tion acute coronary syndromes: A retrospective observational study. Anatolian J Cardiol, 2013; 13: 57–61.Murat Yuksel, Abdulkadir Yildiz, Murat CayliDepartment of Cardiology, Dicle University School of MedicineKalp Hastanesi Kardiyoloji AD, 21280, Sur, Diyarbakir, Turkeytel: (+90) 412 2488001, fax: (+90) 412 2488523e-mail: yukselmurat@yahoo.com352 www.cardiologyjournal.orgCardiology Journal 2015, Vol. 22, No. 3

The prognostic value of white blood cell count-to-mean platelet volume ratio in patients with acute coronary syndrome

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The prognostic value of white blood cell count-to-mean platelet volume ratio in patients with acute coronary syndrome

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