Platelet-to-lymphocyte ratio at the time of carotid endarterectomy is associated with acute coronary syndrome occurrence

Aims Platelet-to-lymphocyte ratio (PLR) and neutrophil-tolymphocyte ratio (NLR) are used in the clinical management of patients at cardiovascular (CV) risk. In this pilot study, we aimed at evaluating the predictive role of NLR and PLR toward the occurrence of acute coronary syndrome (ACS) across an 18-month follow-up period. Correlations involving NLR and PLR with regard to circulating and intraplaque biomarkers have been investigated, too. Methods 196 patients with severe carotid artery stenosis undergoing carotid endarterectomy (CEA) were enrolled at IRCCS Ospedale Policlinico San Martino (Genoa, Italy) from 2008 to 2011. Clinical information and blood samples were collected the day before CEA and patients were clinically followed up for 18 months. Results NLR positively correlated with fibrinogen and intraplaque M1 macrophages. PLR positively correlated with fibrinogen and inversely with triglycerides and CCL5. By a ROC curve analysis, PLR, but not NLR, has been found to predict ACS at 18-month follow-up (cutoff >153.6). Kaplan- Meier analysis demonstrated that patients above the PLR cut-off experienced higher rates of ACS at 18 months. Cox proportional hazard regression analysis confirmed these results irrespective of potential confounders, such as previous coronary artery disease and CV preventive therapy.