New Predictors in Determining the Need for Invasive Treatment in NSTEMI During the COVID-19 Pandemic? A Retrospective Study
Ekrem Aksu1, Deniz Avcı2, Enes Çelik1, Bayram Öztürk1, Mehmet Buğra Bozan3, Kemal Göçer4, Ahmet Çağrı Aykan1
1Department of Cardiology, Faculty of Medicine, University of Kahramanmaras Sutcu Imam, Kahramanmaras, Turkey
2Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
3Department of General Surgery, Faculty of Medicine, University of Kahramanmaras Sutcu Imam, Kahramanmaras, Turkey
4Department of Cardiology, Necip Fazıl City Hospital, Kahramanmaras, Turkey
Keywords: Non-ST elevation myocardial infarction; invasive treatment; neutrophil to lymphocyte ratio; systemic immune-inflammation index.
Introduction: The non-invasive approach has become the first choice for the acute non-ST elevation myocar- dial infarction-acute coronary syndrome (NSTEMI-ACS) during the Coronavirus Disease-2019 (COVID-19) pandemic. However, most of these patients require interventional treatment. In this study, the possible role of hematological inflammatory markers in differentiating medium-high risk NSTEMI-ACS patients according to the GRACE risk classification in need of interventional treatment was investigated.
Patients and Methods: Patients who underwent coronary angiography with the diagnosis of NSTEMI-ACS in a tertiary cardiology clinic between January 2018 and December 2019 were included in the study, which was designed as a retrospective cohort study. NSTEMI-ACS patients (n= 276), except for patients with exclu- sion criteria (n= 32), were divided into two groups as those in need of invasive treatment (n= 217) and medical treatment (n= 59) according to the results of coronary angiography. The hematological inflammatory markers were compared between groups.
Results: Neutrophil to lymphocyte ratio (NLR) (AUC: 0.637, 95% CI: 0.563-0.712, p= 0.001) and systemic immune-inflammation index (SII) (AUC: 0.622, 95% CI: 0.545-0.699, p= 0.004) predicted the requirement of interventional treatment in NSTEMI-ACS.
Conclusion: It is unclear whether the NLR and SII elevation, which may be a predictor of the need for inva- sive treatment, is a cause or a consequence of the pathophysiological process in patients with NSTEMI-ACS. However, elevated NLR and SII values can help distinguish NSTEMI-ACS patients who need invasive treat- ment during the COVID-19 pandemic. The results of this study, show the need for large-sized studies to de- termine the ideal cut-off point of NLR and SII levels in determining the treatment strategy for NSTEMI-ACS
Cite this article as: Aksu E, Avcı D, Çelik E, Öztürk B, Bozan MB, Göçer K, et al. New predictors in determining the need for invasive treatment in NSTEMI during the COVID-19 pandemic? A retro- spective study. Koşuyolu Heart J 2021;24(1):1-7.
The research protocol in line with the Helsinki Declaration was approved by the local ethics committee (Approval Date: 05.08.2020; Protocol No: 2020/15/10).
Due to the design of the study, consent to volunteer could not be obtained from the patients.
Concept/Design - EA, MB; Analysis/Interpretation - EA, DA, MB; Data Collection - EA, EÇ, BÖ; Writing - EA; Critical Revision - EA, DA, KG, AA; Final Approval - EA, AA; Statistical Analysis - DA, MB; Overall Responsibility - EA.
The authors have no conflicts of interest to declare
The authors declared that this study has received no financial support.