Association of serum platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), non-HDL cholesterol levels with severity of acute coronary syndrome

摘要

Background: Acute coronary syndrome (ACS) is associated withemergency hospitalizations, and there are limited real-world dataon clinical outcomes in Asian post-ACS patients. This paper presentsdata on the Indian subgroup from the long term follow-up ofantithrombotic management patterns In Acute CORonary Syndromepatients in Asia (EPICOR-Asia) study.Methods: EPICOR included 12,922 patients with ACS (ST-segmentelevation myocardial infarction [STEMI], non-ST-segment elevationmyocardial infarction [NSTEMI], or unstable angina [UA]).The study had two phases: acute phase and follow-up phase.The primary objective was to describe short- and longtermantithrombotic management patterns (AMPs). Secondaryobjectives were to compare the association of AMPs withclinical outcomes of death and cardiovascular (CV) and bleedingevents.Results: EPICOR-India enrolled 2468 patients (STEMI – 1482;NSTEMI – 562; UA – 424). CV risk factors were present in 55% ofthe population. Pre-hospital care was received by 35% ofpatients, and the average time from symptom onset to firstmedical attention was approximately 7 h. Thrombolysis wasinitiated after admission in 29.1% of STEMI patients, whereascardiac catheterization was performed in 74% of the overallpopulation. The most common drug regimen prescribed duringthe acute phase was ≥2 antiplatelets + anticoagulants with no GPIIb/IIIa inhibitors and at discharge were aspirin + clopidogrel.Post-discharge outcomes at 2 years included death in 166(6.7% [STEMI – 6.9%; NSTEMI – 9.6%; UA – 2.4%]), CV events in177 (7.2% [STEMI – 7.9%; NSTEMI – 8.0%; UA – 3.5%]), compositeevents of death, MI, or ischemic stroke in 182 (7.4% [STEMI –7.6%; NSTEMI – 10.9%; UA – 2.1%]), and bleeding events in 7 (0.3%[STEMI – 0.3%; NSTEMI – 0.2%; UA – 0.2%]).Conclusion: This study has observed a gap between internationalrecommendations and implementation for managing ACS inIndian patients. The poor pre-hospital care, delay in receivingmedical attention, and fewer doctors opting for non-invasiveinterventions are some of the challenges in India. The mortalityalong with composite events of death, MI, or ischemic stroke washighest for NSTEMI patients. The reported CV events were similarin STEMI and NSTEMI groups. Going forward, steps need to betaken to improve identification, diagnosis, and management ofACS patients to improve patient outcomes.