Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio combination for acute coronary syndrome risk stratification: A retrospective observational study from a Metropolitan Medical Center in Taiwan

ObjectiveTo evaluate the prognostic value of the combined neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) for adverse outcomes in Taiwanese patients with acute coronary syndrome (ACS).MethodsThis retrospective, single-center, observational cohort study analyzed 653 ACS patients from the Tri-Service General Hospital-coronary artery disease registry (Jan 2016-Aug 2018). NLR and MLR were calculated at presentation. The primary endpoint was a composite of in-hospital mortality and stroke. Optimal cut-off values were determined using receiver operating characteristic curve analysis (NLR > 5.22, MLR > 0.76). Univariable and multivariable logistic regression were used to assess the association of both elevated NLR/MLR with the primary endpoint.ResultsPatients with both elevated NLR and MLR (NLR > 5.22 and MLR > 0.76) demonstrated a significantly higher risk of the primary endpoint compared to the group with no elevation (OR = 7.16) in univariable analysis. This group also experienced longer hospital stays and higher non-cardiovascular mortality. However, this association became non-significant after multivariable adjustment for confounders.ConclusionsConcurrent elevation of both NLR and MLR at presentation is associated with increased in-hospital morbidity and prolonged hospitalization in ACS patients, although this did not remain an independent predictor in multivariable analysis. Ongoing statin therapy demonstrated a protective association in this cohort. These readily available markers may facilitate early risk stratification.