Monocyte to high-density lipoprotein cholesterol and lymphocyte to monocyte ratios are predictors of in-hospital and long-term mortality in patients with acute coronary syndrome.

OBJECTIVE: We aimed to determine the relationship between LMR and MHR and in-hospital and long-term mortality in patients with ACS. METHODS: We retrospectively collected patients with ACS undergoing coronary angiography between January 2012 and December 2013. RESULTS: In total, 825 patients with a mean age of 62.4 ± 12.9 years (71.3% male) were enrolled in the study. Patients were divided into three tertiles based on MHR levels and LMR levels. In-hospital mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [30 (10.9%) vs 8 (2.9%) and 14 (5.1%); P < .001, P = .009, respectively]. Five-year mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [84 (30.5%) vs 48 (17.5%) and 57 (20.7%); P < .001, P = .005, respectively]. In-hospital mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [25 (9.1%) vs 10 (3.6%) and 17 (6.2%); P = .007, P = .130, respectively]. Five -year mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [77 (28.0%) vs 47 (17.1%) and 65 (23.6%); P = .001, P = .142, respectively]. CONCLUSION: We have shown that high MHR and low LMR were significant and independent predictors of in-hospital and long-term mortality in patients with ACS.

Peripartum cardiomyopathy in Turkey: Experience of three tertiary centres.

We conducted this study to determine demographic details, and clinical presentations in patients with peripartum cardiomyopathy (PPCMP) of Turkish origin. The study population consisted of 58 patients with PPCMP treated at 3 major hospitals in Turkey, retrospectively. In this study, demographic details and initial echocardiographic data were recorded and long-term clinical status was evaluated. The mean age for the patient cohort was 31.47 ± 6.31 years. Thirty-eight patients (73.1%) were multigravida and seven patients had multifetal pregnancy (13.7%). The mean follow-up left ventricular (LV) ejection fraction increased from 31 ± 7 to 38 ± 19. A minority of patients were defined as improvers according to our pre-specified criteria. The average survival period after diagnosis of PPCMP was 20.66 ± 14.44 months. Initial values for LV end-diastolic diameter and urea were higher in the deceased patients compared with the surviving patients, respectively. Twenty-eight (48%) patients with PPCMP showed improvement in the follow-up period. Of the 58 PPCMP patients, 9 (15%) died during a mean follow-up of 32 ± 22 months.

Assessment of atrial electromechanical delay and P-wave dispersion in patients with psoriasis.

BACKGROUND: In this study, we sought to evaluate atrial electromechanical properties and conduction homogeneity by tissue Doppler imaging and electrocardiography in patients with psoriasis. METHODS: Thirty-four patients with psoriasis and 30 age- and gender-matched healthy controls were included in the study. Atrial electromechanical coupling intervals were assessed by means of tissue Doppler echocardiography and P-wave dispersion (Pd) was calculated from electrocardiogram. RESULTS: A total of 64 subjects (33 male) with a mean age of 36.8 ± 11.9 years were included in the study. Basal characteristics were similar between 2 groups. Intra-atrial (15 ± 7 ms vs. 12 ± 5 ms, P = 0.009) and inter-atrial (28 ± 7 ms vs. 23 ± 7 ms, P = 0.002) electromechanical delays were significantly higher in patients with psoriasis compared with control groups. P-maximum (112 ± 16 ms vs. 103 ± 8 ms, P = 0.006) and Pd (35 ± 9 ms vs. 20 ± 6 ms, P < 0.001) were also prolonged in patients with psoriasis. CONCLUSION: This study demonstrated that atrial electromechanical coupling intervals and P-wave dispersion were prolonged in patients with psoriasis, which may cause an increased risk of atrial fibrillation in this patient group.

A simple method for the assessment of arterial stiffness in pre-eclamptic patients.

BACKGROUND: Arterial stiffness (AS), the term describes the rigidity of arterial walls, and its hemodynamic results have been shown to be associated with increase in future cardiovascular events. Women with pre-eclampsia in their past pregnancies have a higher risk of developing cardiovascular disease later in life. The goal of this study was to assess AS using a non-invasive and simple oscillometric method in pregnant women with and without pre-eclampsia. METHODS: Ninety pregnant women, forty-five of which had pre-eclampsia, were included in the study. The vascular measurements were performed with a Mobil-O-Graph 24 h PWA Monitor, an automatic oscillometric device. Statistical analysis was performed using the Chi-square, independent sample t-test or the Mann-Whitney U test, Pearson correlation, and linear regression tests. RESULTS: All the vascular function parameters were significantly higher in the patients with pre-eclampsia. The pulse wave velocity (PWV) values found in the pre-eclampsia group were positively correlated with gestational age, maternal age, glucose level, creatinine level, augmentation index, and central blood pressure. Using linear regression analysis, the PWV values were confirmed to be positively correlated with gestational age, maternal age, and central systolic blood pressure. The women with severe pre-eclampsia had significantly higher blood pressures, PWV values, augmentation indices, and cardiac outputs when compared with the patients with mild pre-eclampsia. CONCLUSION: Oscillometric PWV measurement is already accepted as the most reproducible quick, simple, and inexpensive non-invasive method for the assessment of large artery stiffness. It can be applied to evaluate the AS and also aid in detecting future cardiovascular risk of patients with pre-eclampsia.

The prognostic significance of serum albumin in patients with acute decompensated systolic heart failure.

BACKGROUND: Despite improvements in the diagnosis and treatment of heart failure, mortality is still high. It is important to identify high-risk patients. In this study, we investigated whether the serum albumin level is a useful predictor of annual mortality in patients with acute decompensated systolic heart failure (ADSHF). METHODS: One-hundred and thirty-five consecutive patients with a left ventricular ejection fraction ≤ 40% who were hospitalized with the diagnosis of ADSHF were included in this retrospective study. Patients were divided into two groups based on whether or not hypoalbuminaemia was present, and the relationship between hypoalbuminaemia and mortality was evaluated. RESULTS: The mean age of the study population was 67 ± 14 years and 54% of the patients were male. Hypoalbuminaemia was detected in 69.6% of the patients. The systolic blood pressure, haemoglobin levels, lymphocyte count, cholesterol and sodium values were low and the direct bilirubin and CRP levels were elevated in the hypoalbuminaemia group. The one-year mortality was 37% in the hypoalbuminaemia group and 12% in the group with normal albuminaemia (P = 0.003). Multivariate analysis showed that hypoalbuminaemia, decreased haemoglobin levels and increased creatinine values were independent predictors of mortality (P < 0.05). A serum albumin cut-off value of 3.10 g/dl predicted 1-year mortality with a sensitivity of 70% and specificity of 70% in patients with ADSHF disease. CONCLUSION: All-cause annual mortality rates are significantly increased in ADSHF patients with hypoalbuminaemia. The serum albumin level, as well as the creatinine and haemoglobin values, may be helpful biomarkers in this group.

Echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio are novel inflammatory predictors of cerebral ischemic stroke.

BACKGROUND: The role of epicardial fat thickness (EFT) in ischemic stroke (IS) has not been previously investigated. The aim of the present study was to evaluate EFT and neutrophil/lymphocyte ratio (NLR) among patients with IS and to examine the relationship between these inflammatory markers and the incidence of IS. METHODS: The cross-sectional design includes 38 patients with IS and 47 age- and sex-matched healthy controls. Echocardiographic measurement of EFT was conducted according to previously published methods. An automated hematology analyzer was used to generate total and differential leukocyte counts from patient blood samples. RESULTS: Mean EFT was 4.86 ± .68 mm in the control group and 5.95 ± 1.14 mm in the IS group. EFT was significantly greater in the IS patients in relation to the control group (P < .001). Mean NLR was significantly greater among IS patients in relation to the control group (2.5 ± .6 vs. 1.8 ± .4, P < .001). No significant confounding factors were identified in the data set. Spearman's correlation analysis revealed a mild, but highly significant correlation between EFT and NLR (r = .293, P = .006). CONCLUSIONS: This study demonstrates for the first time the association between EFT and cerebral IS. Echocardiographic EFT was significantly correlated with NLR. NLR and echocardiographic EFT represent inexpensive and readily available clinical markers that maybe useful in estimating risk of IS.

[Assessment of right ventricular systolic function in patients with chronic renal failure before and after hemodialysis by means of various echocardiographic modalities]. / Kronik böbrek yetersizligi olan hastalarda hemodiyaliz öncesi ve sonrasi sag ventrikül sistolik fonksiyonlarinin farkli ekokardiyografi yöntemleri ile degerlendirilmesi.

OBJECTIVES: The goal of the study was to determine the effect of decreased preload on right ventricular systolic function, as measured by new and old echocardiographic parameters in chronic renal failure (CRF) patients. STUDY DESIGN: A total of 30 CRF patients (mean age 48±15 years, 11 male and 19 female) undergoing hemodialysis were included in the study. Echocardiography was used to determine left ventricular ejection fraction (LVEF), left atrial volume, right atrial area, right ventricular end-diastolic area, systolic pulmonary artery pressure, right ventricular fractional area change (RV FAC), right ventricular myocardial performance index (Tei index), right ventricular tissue Doppler S' (RV S') velocity, isovolumic myocardial acceleration (IVA), tricuspid annular plane systolic excursion (TAPSE) and right ventricular outflow tract systolic excursion (RVOT SE) before and after hemodialysis. RESULTS: The RV S' velocity and RVOT SE parameters, which are indicators of right ventricular systolic function, did not change significantly after hemodialysis (p=0.919, p=0.186). However, the RV FAC, Tei index, IVA and TAPSE values were significantly increased (p<0.001 for all). TAPSE was found to be the only parameter that had a positive correlation with the amount of fluid removed (p=0.041 and r=0.375). CONCLUSION: Although RV S' velocity and RVOT SE, was found to be independent of preload, RV FAC, Tei index, IVA and TAPSE values were dependent on preload. In addition, TAPSE correlated with the amount of fluid removed.

The relationship between QT dispersion and exaggerated blood pressure response to exercise stress testing.

This study was aimed to investigate sensitivity and specificity of QT dispersion (QTd) as a predictor of hypertensive response to peak exercise stress testing (EST). Fifty-nine patients were divided in to two groups (32 patients with exaggerated blood pressure response (EBPR) to EST group and 27 patients for normotensive group) and the EST was monitored. The QTd and corrected QT (QTc) intervals were still found to be significant predictors of EBPR (P < 0.05). In receiver operating characteristic (ROC) analysis, a level of QTd ≥ 40 predicted EBPR with 84% sensitivity and 74% specificity. According to the present data, QTd might be an important predictive marker for EBPR.

Association between neutrophil to lymphocyte ratio and pulmonary arterial hypertension.

OBJECTIVES: Pulmonary hypertension (PH) is composed of a heterogeneous group of disorders marked by increased pulmonary artery resistance leading to right heart failure, with high mortality. Evidence is increasing to propose that inflammation plays a significant role in the pathophysiological mechanism. Increased prevalence of PH in patients with systemic inflammatory diseases is already known. Herein, we sought to evaluate the association between neutrophil to lymphocyte ratio (N/L ratio) and pulmonary arterial hypertension (PAH). STUDY DESIGN: Twenty-five patients with PAH and 25 controls were evaluated. Baseline clinical and echocardiographic variables were obtained. Complete blood counts in all patients and controls were reviewed retrospectively. RESULTS: The N/L ratio was higher in patients with PAH compared to healthy volunteers (p=0.05). A cut-off value of 1.65 for N/L ratio predicted the presence of PAH with 72% sensitivity and 69% specificity. After multivariate analysis, only N/L ratio remained a significant predictor of PAH. CONCLUSION: We showed for the first time that N/L ratio was significantly increased in patients with PAH compared to controls.

Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER study.

OBJECTIVES: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. STUDY DESIGN: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. RESULTS: The mean age of the patients was determined as 66.8 ± 12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co-morbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. CONCLUSION: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

Estimated plasma volume is not a robust indicator of the severity of congestion in patients with heart failure.

BACKGROUND: Congestion is the main cause of morbidity and a prime determinant of survival in patients with heart failure (HF). However, the assessment of congestion is subjective and estimation of plasma volume (ePV) has been suggested as a more objective measure of congestion. This study aimed to explore the relationships and interactions between ePV, the severity of congestion and survival using a nationwide registry. METHODS: Of the 1054 patients with HF enrolled in the registry, 769 had sufficient data to calculate ePV (using the Duarte, Kaplan, and Hakim equations) and relative plasma volume status (rPVS), and these patients were subsequently included in the present analysis. The severity of congestion was assessed using a 6-point congestion score (CS). Patients were divided into three groups according to the degree of congestion. RESULTS: Out of four equations tested, only ePVDuarte and rPVS were statistically higher in patients with severe congestion as compared to patients with no congestion (p<0.001 for both). Both ePVDuarte (r = 0.197, p<0.001) and rPVS (r = 0.153, p<0.001) showed statistically significant correlations with CS and both had a modest accuracy (70.4% for ePVDuarte and 69.4% for rPVS) to predict a CS ≥3. After a median follow up of 496 days, both ePVDuarte (OR:1.14,95%CI:1.03-1.26, p = 0.01) and rPVS (OR:1.02, 95%CI:1.00-1.03, p = 0.03) were associated with all-cause mortality after adjusting for demographic and clinical variables. However, none of the indices were associated with mortality following the introduction of CS to the models (p>0.05 for both). CONCLUSIONS: Elevated ePVDuarte and rPVS were indicators of congestion but with a limited robustness, and either parameter could be clinically useful when a comprehensive clinical evaluation of congestion is not feasible.

Frequency of pulmonary hypertension in patients with COPD due to biomass smoke and tobacco smoke.

OBJECTIVES: Pulmonary hypertension (PH) is a common and well established complication of chronic obstructive pulmonary disease (COPD). Its presence is associated with decreased survival. This study was designed to investigate the PH frequency and its relations in hospitalized tobacco and biomass related COPD patients. METHODS AND RESULTS: The study was a retrospective review of inpatients with COPD defined as a history of tobacco or biomass smoking, Pulmonary function tests (PFT) within stable status, an echocardiogram within stable status. PH was defined as systolic pulmonary artery pressure (sPAP) >35 mmHg. Of the 694 individuals, 600 had suitable aspects for inclusion of study. All Females were biomass exposer and males were tobacco smoker. The Prevalence of PH was found more frequent in females than males. It was more prominent in moderate level COPD cases (56,2% and 37,5%, P<0,002). Both groups had airflow limitation, hypercapnia and hypoxemia, but no differences were found in terms of PaCO(2) and PaO2. However, FEV1 % was lower in males than females (p<0,005). On the other hand, FVC % was lower in the females compared with the males (p < 0.02). When analyzing the influence of PFT and demographic parameters on PH in separate COPD level groups, the results a bit varied among the groups. CONCLUSION: Our study demonstrated that PH frequency is higher in female COPD cases due to biomass smoke than in male COPD cases due to tobacco smoke. The influence of FVC % on the risk of a person having PH increased with increasing COPD level.

Novel predictor of pulmonary arterial hypertension: Monocyte to HDL cholesterol ratio.

Monocyte to HDL cholesterol ratio (MHR), lymphocyte to monocyte ratio (LMR), and neutrophil to lymphocyte ratio (NLR) have been proposed as novel systemic inflammatory markers. The aim of this study was to explore the association between MHR, LMR and NLR with pulmonary arterial hypertension (PAH). The study is a single-center, retrospective Cross-sectional study. The study group consisted of 73 patients with PAH and the control group 77 participants without cardiac pathology as determined by echocardiography. On admission, blood sampling to calculate MHR, LMR, NLR, and detailed clinical data were obtained. According to the Pearson test, systolic pulmonary artery pressure (PAP) value Higher MHR, NLR and lower LMR that indicates an enhanced inflammation were significantly increased in patients with PAH when compared with controls. Compared to many other inflammatory markers, these markers are widely available. positively correlated with the MHR and NLR (r:.35, P < .001 and r:.33, P < .001, respectively), but negatively correlated with LMR (r: -.26, P = .001). After multivariate logistic regression analysis, MHR, LMR, and NLR remained as significant predictors of PAH (OR: 2.651, 95% CI: 1.227-5.755, P = .007; OR: 0.647, 95% CI:0.450-0.931, P = .005; OR: 1.350, 95% CI: 1.054-1.650 P = .030, respectively).

Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: A follow-up data for mortality.

OBJECTIVE: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided. METHODS: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM. RESULTS: There were 1054 patients with a mean age of 63.3±13.3 years and with a median follow-up period of 16 (7-17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores ≤1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year. CONCLUSION: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 year.

Normal echocardiographic measurements in a Turkish population: The Healthy Heart ECHO-TR Trial.

OBJECTIVE: Normal reference values for the cardiac chambers are widely based on cohorts from European or American populations. In this study, we aimed to obtain normal echocardiographic measurements of healthy Turkish volunteers to reveal the age, gender, and geographical region dependent differences between Turkish populations and other populations. METHODS: Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination. Blood biochemical parameters were also obtained for all patients on admission. The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used to assess the echocardiographic cardiac chamber quantification. RESULTS: The study included 1154 volunteers (men: 609; women: 545), with a mean age of 33.5±11 years. Compared to men, women had a smaller body surface area, lower blood pressure and heart rate, lower hemoglobin, total cholesterol, lower low-density lipoprotein (LDL) levels, and higher high density lipoprotein (HDL) levels. Cardiac chambers were also smaller in women and their size varied with age. When we compared the regions in Turkey, the lowest values of left cardiac chamber indices were seen in the Marmara region and the highest values were observed in the Mediterranean region. Regarding the right cardiac indices, the Mediterranean region reported the lowest values, while the Black Sea region and the Eastern Anatolia region reported the highest values. CONCLUSION: This is the first study that evaluates the normal echocardiographic reference values for a healthy Turkish population. These results may provide important reference values that could be useful in routine clinical practice as well as in further clinical trials. (.

The utility of the TIMI risk index on admission for predicting angiographic no-reflow after primary percutaneous coronary intervention in patients with STEMI.

BACKGROUND/AIM: The thrombolysis in myocardial infarction (TIMI) risk score (TRS), and the TIMI risk index (TRI) have been reported in coronary artery disease patients. We investigated whether admission TRI is associated with no-reflow (NRF) in patients undergoing primary percutaneous coronary intervention (p-PCI). MATERIALS AND METHODS: ST-segment elevation myocardial infarction (STEMI) patients treated with p-PCI were included in the study. TRI was calculated on admission using specified variables. We defined the angiographic NRF phenomenon as a coronary TIMI flow grade of ≤2 after the vessel was recanalized or a TIMI flow grade of 3 together with a final myocardial blush grade (MBG) of <2 in a manner as described in previous studies. RESULTS: A total of 371 patients (aged 62 ± 14 years; 73/27 men to women ratio) who underwent p-PCI were enrolled in the study. In terms of age, NRF patients were older than reflow patients (P < 0.017 for MBG). Killip class III-IV designations were more common in NRF patients (P = 0.029 for MBG). TRI (P = 0.014 for MBG) values were significantly greater in the NRF group. TRI was an independent predictor of NRF according to MBG flow (P = 0.003, B = -0.035, Exp B = 0966, 95% CI, 0.944-0.988). CONCLUSION: Admission TRI may predict the development of NRF phenomenon after p-PCI in patients with acute STEMI.

Serum Levels of IL-17 and IL-23 in Patients With Rheumatic Mitral Stenosis.

Rheumatic mitral valve stenosis (RMS) is a complication of rheumatic heart disease (RHD) and leads to significant morbidity and mortality. RHD is a chronic inflammatory and autoimmune disease that is associated with cytokine activities. The etiology of RMS is not fully understood yet. Interleukin (IL)-17 and IL-23 have a key role in development of the autoimmunity. The expression of these cytokines in RMS remains unclear. In this study, we investigated the serum levels of IL-17 and IL-23 in RMS patients compared to healthy subjects.A total of 35 patients admitted to cardiology outpatient clinic between December 2014 and May 2015 who were diagnosed with RMS formed the study group. Age- and gender-matched 35 healthy subjects were included as the control group. Statistical analyses were performed using SPSS 18.0 and P value <0.05 was considered as statistically significant.The patients with RMS had higher WBC count, hsCRP, systolic pulmonary artery pressure (PAPs), left atrial diameter (LAD), IL-17, and IL-23 levels compared to the control subjects. The levels of IL-17 (P = 0.012) and IL-23 (P = 0.004) were significantly higher in the RMS group. Correlation analysis revealed that IL-17 and IL-23 levels had a significant correlation with each other and with hsCRP and LAD.We demonstrated that serum levels of IL-17 and IL-23 are significantly higher in patients with RMS compared to those of healthy subjects. IL-17 and IL-23 expression may have a possible role in inflammatory processes that result in RMS development.

Relationship Between Hematologic Indices and Global Registry of Acute Coronary Events Risk Score in Patients With ST-Segment Elevation Myocardial Infarction.

The aim of this study was to evaluate the relationship between hematologic indices and the Global Registry of Acute Coronary Events (GRACE) score in patients with ST-segment elevation myocardial infarction (STEMI). A total of 800 patients who consecutively and retrospectively presented with STEMI within 12 hours of symptom onset. After accounting for exclusion criteria, a total of 379 patients remained in the study. We enrolled 379 patients with STEMI (mean age 61.7 ± 13.6 years; men 73%). Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), and monocyte count were associated with increased worse GRACE risk score (P = .008, P = .012, P = .005, P = .022, respectively). In multivariate linear regression analysis, NLR, PLR, RDW, and monocyte count were found to be independent predictors of GRACE risk score. We demonstrate for the first time that PLR, RDW, and monocyte were associated with the GRACE score in patients with STEMI.