RESUMO
BACKGROUND: The value of counting inflammatory cells and especially their counting ratio in predicting adverse clinical outcomes in patients with acute coronary syndrome (ACS) undergoing revascularization has been shown, but the results of studies have been very diverse and paradoxical. The aim of the current study was to systematically review the studies that investigated the role of increased neutrophil-to-lymphocyte ratio (NLR) in predicting long-term clinical outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS: Data abstraction was independently performed by both un-blinded reviewers on deeply assessing Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials and using the relevant keywords. The risk of bias for each study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions and the QUADAS-2 tool. Statistical analysis was performed using the Stata software. Overall, 14 articles published between 2010 and 2021 were eligible for the final analysis. RESULTS: A total of 20,846 ACS patients undergoing PCI were included. Higher values of NLR were associated with higher numbers of involved coronaries (RR: 1.175, 95%CI 1.021-1.353, P = 0.024). Increasing the value of NLR was associated with a 3.4 times increase in long-term death (RR: 3.424, 95%CI 2.325-5.025, P = 0.001). Similarly, higher values of NLR were significantly associated with a higher likelihood of long-term MACE (RR: 2.604, 95%CI 1.736-3.906, P = 0.001). CONCLUSIONS: NLR has a high value in predicting both the severity of coronary artery involvement and long-term adverse clinical outcomes following the PCI procedure.
RESUMO
ST-segment elevation myocardial infarction (STEMI) is one of the fatal complications following Covid-19. We aimed to systematically assess the clinical sequels as well as cardiovascular findings in patients suffering STEMI following Covid-19.The manuscripts databases including PubMed, Web of knowledge (ISI), SCOPUS, Embase, and Google Scholar were deeply searched by the two reviewers using the relevant keywords related to the issue considered in the current review. Of 88 studies initially reviewed, 9 articles were included in final assessment. Nine articles including 447 patients with Covid-19 were included in the study. In terms of electrocardiographic findings, anterior lead involvement was reported in 12% - 61.6% of cases, inferior lead in 28.2% - 75% and lateral involvement in 7.7% - 100% of cases. The prevalence of LBBB was in the range of 10.7% - 61.6% of cases. In terms of echocardiographic findings, a decrease in left ventricular ejection fraction was reported in 60% - 88% of patients. Wall motion abnormality was also observed in 60% - 82.1% of patients. In terms of angiographic findings, the multi-vessel disease was reported in 17.9% - 69% of cases. Also, 24% - 83% of cases needed to revascularization procedures. Cardiac arrest was also reported in 3.1% - 28.2% of cases. Based on the meta-analysis performed on the mortality of patients with STEMI in the field of Covid-19, the pooled prevalence of mortality was estimated at 25.2% (95%CI:17.5%-34.8%). Mortality and adverse consequences of STEMI in patients with Covid-19 are far higher than in the general population. Therefore, in-hospital cardiovascular tracking and monitoring of Covid-19 patients with potential cardiovascular disorders is necessary to achieve a more favorable outcome.
