Association Of Lymphocyte To Monocyte Ratio With Sevetrity And Prognosis Of Coronary Artery Disease

Background:Coronary atherosclerotic heart disease is a kind of heart disease,which is caused by coronary artery stenosis or occlusion,resulting in myocardial ischemia,hypoxia or necrosis,often referred to as "coronary heart disease".Coronary heart disease is a middle-aged and elderly disease,which is common in adults over 40 years old.The incidence of Coronary heart disease in women is later than that in men,after menopause,the incidence is gradually equal to that in men.However,the incidence of Coronary heart disease has shown a trend of younger in recent years.The morbidity and mortality of coronary heart disease are in the first place of chronic non-communicable diseases,which seriously threaten human health and placed a huge burden on our national economy.Coronary heart disease is caused by many reasons,which are the basis of pathology;intervention of these factors may reduce the incidence of Coronary heart disease and delay the further progress.Objectives:The aim of this study was to investigate the relationship between lymphocyte to monocyte ratio and the severity of coronary artery disease and cardiovascular events in patients undergoing angiography.Methods:We collected all patients who suspected and diagnosed coronary heart disease undergoing coronary angiography at Department of cardiology of Qilu Hospital of Shandong University between June 2015 and December 2016.According to strict inclusion and exclusion criteria,a total of 199 patients,who had undergone coronary angiography,were included in the study and retrospectively analyzed.First,all patients were divided into two groups according to the results of coronary angiography(lumen stenosis ? 50%as meaningful stenosis):49 patients in control group(without meaningful stenosis of coronary artery)and 150 patients in coronary artery disease group(with meaningful stenosis of coronary artery).Then,coronary artery disease group patients were divided into two groups according to Gensini score:66 patients in mild coronary stenosis group(Gensini score ? 40)and 88 patients in severe coronary stenosis group(Gensini score>40).We obtained the incidence of major adverse cardiovascular events of coronary artery disease group patients by telephone follow-up.All data were analyzed by SPSS 19.0 statistical software.Results:Our results showed that the rate of male gender,hypertension,smoking,white blood cell,neutrophil and monocytes were significantly higher in coronary artery disease group as compared with control group(P<0.05).However,high density lipoprotein and lymphocyte to monocyte ratio were significantly lower in coronary artery disease group as compared with control group.Those in the severe atherosclerosis group had significantly higher incidence of diabetes,whereas the group that had lower Gensini score tended to have higher high density lipoprotein cholesterol,lymphocyte and lymphocyte to monocyte ratio.In the correlation analysis,Gensini score was significantly positively correlated with the rate of male gender,diabetes mellitus,creatinine,neutrophil and monocytes,it was significantly negatively correlated with high density lipoprotein,Left ventricular ejection fraction,lymphocyte and lymphocyte to monocyte ratio.Furthermore,multivariate logistic regression analysis demonstrated that lymphocyte to monocyte ratio(OR,0.715;95%confidence interval,0.551-0.927;P=0.012)was independent predictors of severe atherosclerosis.Using a cut-off level,lymphocyte to monocyte ratio predicted severe atherosclerosis with a sensitivity of 57.1%and specificity of 69.7%(area under curve[AUC],0.634;95%confidence interval,0.545?0.724;P= 0.005).Then coronary artery disease group was divided into 2 groups according to the lymphocyte to monocyte ratio value of 5.06.And we obtained the incidence of major adverse cardiovascular events through telephone follow-up.Kaplan-Meier analysis found patients with lymphocyte to monocyte ratio?5.06 had a higher rate of cardiovascular events and worse prognosis.Conclusions:Our study demonstrated that the ratio of lymphocyte to monocyte was associated with the severity of coronary atherosclerosis,providing a new insight in the application of inflammation index evaluating the severity of coronary artery disease.The ratio of lymphocyte to monocyte can be used as a reliable predictor of coronary artery stenosis,and is more sensitive than lymphocytes and monocytes,and has higher diagnostic value.Lymphocyte to monocyte ratio may also be a useful indicator for predicting future cardiovascular events in patients with coronary heart disease.