Impact of serum erythropoietin level on collateral vessel development in patients with coronary artery disease

The Relationship Between Neutrophil/Lymphocyte Ratio Before Coronary Angiography and Coronary Collateral Development

OBJECTIVE

The aim of this study was to determine the relationship between the neutrophil/lymphocyte ratio (NLR) measured before coronary angiography and coronary collateral (CC) development.

METHOD

This retrospective descriptive study was carried out between January 2012 and June 2013 in the cardiology outpatient clinic of a university hospital in Aydın, with 165 patients who were diagnosed with acute coronary syndrome or stable angina pectoris and who had 95% or more stenosis in at least one coronary artery according to angiography. Coronary artery stenosis was determined by Gensini scoring. The classification of CC was performed by the Rentrop method, and patients were divided into two groups: Rentrop stages 0 and 1 (poor CC filling (group 1)) and Rentrop stages 2 and 3 (good CC filling (group 2)). The data were analyzed using appropriate statistical analyses. Multivariate logistic regression was used to determine the predictors of CC level, and receiver operating characteristic (ROC) curve analysis was performed to calculate the predictive value of predictors.

RESULTS

When the groups were compared, the mean age (p=0.023), Gensini score (p<0.001), smoking status (p=0.012), creatinine level (p=0.032), and aspartate aminotransferase level (p=0.032) of the patients in group 1 were significantly lower than those in group 2, while their total cholesterol (p=0.006) and low-density lipoprotein (LDL) levels (p=0.020) were higher. Neutrophils (p=0.016) and NLR (p<0.001) were significantly higher in group 2 patients. A significant positive correlation was found between CC level and neutrophils (p=0.035) and NLR (p=0.011). In regression analysis, high NLR, high Gensini score, and smoking were predictors of good CC filling. According to ROC curve analysis, the sensitivity and specificity of NLR ≥3.53 at the time of presentation to the clinic for predicting good CC filling were 37.6% and 85%, respectively.

CONCLUSION

This study showed that NLR was significantly associated with the development of good CC filling; as NLR increased, the development of good CC filling increased in patients.

Are There Any Cardioprotective Effects or Safety Concerns of Erythropoietin in Patients With Myocardial Infarction? A Systematic Review

Myocardial infarction (MI) is a global cause of morbidity and mortality. MI is the outcome of a chronic process termed atherosclerosis, a buildup of fatty and other substances called plaques inside the coronary vessels, causing hardening and thickening of the arterial wall. Erythropoietin (EPO) is a pleiotropic cytokine released mainly by the kidneys in adults. Besides its well-known erythropoietic functions, EPO possesses anti-apoptotic, mitogenic, and angiogenic effects. This review aims to analyze the strength of any therapeutic or protective value of EPO on the heart and safety concerns regarding its administration in MI individuals. This systematic review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Four databases (PubMed, PubMed Central, Google Scholar, and Sciences Direct) were employed to search for articles published in the last 10 years. Focused studies were relevant articles in the English language, trials, reviews, meta-analyses, and studies with a control group. Following the quality assessment process, nine studies were eligible and hence were included in the review consisting of six randomized controlled trials and three systematic reviews and meta-analyses. Contrary to preclinical studies, EPO administration did not significantly have notable effects on mortality, major adverse cardiovascular events, or infarction size reduction. Significant left ventricle ejection fraction amelioration was not appreciated either. However, EPO seems to reduce the incidence of post-MI arrhythmias.