Platelet to lymphocyte ratio predicting 6-month primary patency of drug-coated balloon for femoropopliteal disease

Development and validation of a nomogram for in-stent restenosis within 2 years in patients after iliac or femoral artery stent placement

OBJECTIVE

This study aimed to analyze the risk factors for in-stent restenosis (ISR) within 2 years after iliac or femoral artery stent placement.

METHODS

Clinical data of 237 patients diagnosed with peripheral arterial disease (PAD) and receiving iliac or femoral artery stent placement for the first time in the Third Hospital of Hebei Medical University from January 2015 to December 2022 were analyzed. Patients were randomized into training and validation set (7:3). Logistic regression was used to perform univariate and multivariate analysis on the possible factors of ISR, identify independent risk factors, establish a risk nomogram prediction model, and internally verify the predictability and accuracy of the model.

RESULTS

Binary logistic regression analysis showed that diabetes, hyperlipidemia, hyperfibrinogenemia and below-the-knee run-offs were independent risk factors for ISR within 2 years after iliac or femoral artery stent placement in patients with PAD. Based on these factors, the risk prediction model is established. The c index of the model was 0.856. The results showed that the risk prediction model has good accuracy in predicting ISR within 2 years after iliac or femoral artery stent placement.

CONCLUSIONS

The risk prediction model based on the 4 risk factors of diabetes, hyperlipidemia, hyperfibrinogenemia and below-the-knee run-offs has good predictive performance.

A systematic review of the neutrophil to lymphocyte and platelet to lymphocyte ratios in patients with lower extremity arterial disease

Lower extremity arterial disease (LEAD) is caused by atherosclerotic plaque in the arterial supply to the lower limbs. The neutrophil to lymphocyte and platelet to lymphocyte ratios (NLR, PLR) are established markers of systemic inflammation which are related to inferior outcomes in multiple clinical conditions, though remain poorly described in patients with LEAD. This review was carried out in accordance with PRISMA guidelines. The MEDLINE database was interrogated for relevant studies. Primary outcome was the prognostic effect of NLR and PLR on clinical outcomes following treatment, and secondary outcomes were the prognostic effect of NLR and PLR on disease severity and technical success following revascularisation. There were 34 studies included in the final review reporting outcomes on a total of 19870 patients. NLR was investigated in 21 studies, PLR was investigated in two studies, and both NLR & PLR were investigated in 11 studies. Relating to increased levels of systemic inflammation, 20 studies (100%) reported inferior clinical outcomes, 13 (92.9%) studies reported increased disease severity, and seven (87.5%) studies reported inferior technical results from revascularisation. The studies included in this review support the role of elevated NLR and PLR as key components influencing the clinical outcomes, severity, and success of treatment in patients with LEAD. The use of these easily accessible, cost effective and routinely available markers is supported by the present review.

Value of the Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting CPET Performance in Patients with Stable CAD and Recent Elective PCI

Background and Objectives: Functional capacity (FC) assessed via cardiopulmonary exercise testing (CPET) is a novel, independent prognostic marker for patients with coronary artery disease (CAD). Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are two readily available predictors of systemic inflammation and cardiovascular event risk, which could be used as cost-effective predictors of poor FC. The purpose of this study was to evaluate the utility of NLR and PLR in predicting poor FC in patients with CAD and recent elective percutaneous coronary intervention (PCI). Materials and Methods: Our cross-sectional retrospective analysis included 80 patients with stable CAD and recent elective PCI (mean age 55.51 ± 11.83 years, 71.3% male) who were referred to a cardiovascular rehabilitation center from January 2020 to June 2021. All patients underwent clinical examination, cardiopulmonary exercise testing on a cycle ergometer, transthoracic echocardiography and standard blood analysis. Results: Patients were classified according to percent predicted oxygen uptake (% VO2 max) in two groups—poor FC (≤70%, n = 35) and preserved FC (>70%, n = 45). There was no significant difference between groups regarding age, gender ratio, presence of associated comorbidities, left ventricular ejection fraction and NLR. PLR was higher in patients with poor FC (169.8 ± 59.3 vs. 137.4 ± 35.9, p = 0.003). A PLR cut-off point of 139 had 74% sensitivity and 60% specificity in predicting poor FC. After multivariate analysis, PLR remained a significant predictor of poor functional status. Conclusions: Although CPET is the gold standard test for assessing FC prior to cardiovascular rehabilitation, its availability remains limited. PLR, a cheap and simple test, could predict poor FC in patients with stable CAD and recent elective PCI and help prioritize referral for cardiovascular rehabilitation in high-risk patients.