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￭ S-203 ￭
Combined predictive value of diabetes and neutrophil to lymphocyte ratio for significant CAD
Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine
*Yun Kyung Kim, Kyoung-Im Cho, Bong-Joon Kim, Hyun-Su Kim, Jung-Ho Heo, Tae-Joon Cha
Background: Coronary artery disease (CAD) is the leading cause of mortality among diabetic patients, and the neutrophil-to-lymphocyte ratio (NLR) has been shown to be an important inflammatory marker for predicting cardiovascular events. This study aimed to evaluate the combined impact of dia- betes mellitus (DM) and NLR on the prevalence of significant CAD and carotid artery atherosclerosis. Methods: Consecutive patients undergoing cor- onary angiography and carotid ultrasonography (US) were included in this study. Significant CAD was defined as at least onevessel with stenosis great- er than 50%. Diabetic status, NLR value and their correlation with parameters of carotid atherosclerosis were analyzed. Results: DM was observed in 190 of 839 patients (22.6%). Compared to the non-diabetics, they were older, had higher NLRs (2.23 ± 1.77 vs. 2.85 ±3.52, p＝0.018), higher-risk car- diovascular profile and a greater prevalence of CAD. Additionally, diabetic patients had a higher prevalence of carotid atherosclerosis. Patients were classified into four groups based on diabetic status and optimal cut-off values for the NLR by receiver operating characteristic analysis. Diabetic pa- tients with a high NLR (≥2.0) had the greatest prevalence of significant CAD, severe CAD, and carotid artery atherosclerosis among all groups. On bi- nary logistic multivariate analysis, an NLR ≥2.0 [odds ratio (OR) 1.85, 95% confidence interval (CI) 1.31 to 2.60, p＜0.001] and the presence of DM (OR 1.94, 95% CI 1.28 to 2.93, p＝0.002) were independent predictors of significant CAD after adjusting for cardiovascular risk factors. Moreover, the presence of DM with as NLR ≥2.0 was a synergistic predictor of CAD (OR 3.47, 95% CI 2.08 to 5.76, p＜0.001). Conclusions: The NLR is increased in T2DM patients, and a high NLR and the presence of T2DM are independent and synergistic predictive risk factors for the prevalence and severity of CAD. Further studies are needed to confirm the present results and to evaluate the underlying pathophysiological mechanisms behind our findings.
￭ S-204 ￭
Is Routine Combination of RAAS and BB Beneficial in Low-risk Myocardial Infarction Patients?
1Division of Cardiology, Department of Internal Medicine, Gwangju Veterans Hospital, Gwangju, Korea, 2Division of Cardiology, Department of Internal Medicine, Chonnam National University, College of Medicine, Chonnam National University Hospital, Gwangju, Korea
*Young Eun Jo1, Wan Kim1, Sun Ho Hwang1, Won Yu Kang1, Sang Cheol Cho1, Kyung Hwan Kim1, Sang Woo Jeong1, Gyu Ik Lee1, Myung Ho Jeong 2, Young Keun Ahn2
Background: The benefit of renin-angiotensin system (RAS) blocker is controversial in low-risk myocardial infarction (MI) patients. This study was done to address the additional benefit of combination of RAS blocker and beta blocker in low-risk MI patients, when compared with beta blocker alone.
Methods: Total 15759 MI patients were enrolled from the Korean Myocardial Infarction Registry and divided into two groups according to the pre- scription of beta blocker or RAS blocker. The high-risk MI patients such as systolic dysfunction, heart failure and previous history of MI were excluded in this study. The 13681 patients treated by beta blocker and RAS blocker were defined as group A and 2078 patients treated by beta blocker without RAS blocker were defined as group B. The primary end point was major adverse cardiac event (MACE) which was defined as composite of cardiac death, non-fatal MI, target vessel revascularization and coronary artery bypass surgery. The secondary end point is respective cardiac death, non-fatal MI, target vessel revascularization and target lesion revascularization. Results: The combination of RAS blocker and beta blocker did not reduce the risk of MACE, when compared beta blocker alone (HR＝0.963, 95% CI; 0.762-1.216, p＝0.749). After propensity matching, the result of survival anal- ysis was similar (HR＝0.909, CI; 0.634-1.302, p＝0.602). And the incidence of respective secondary end point was not different between group A and group B. Conclusions: The routine addition of RAS blocker to beta blocker had not additional benefit in low-risk MI patients. Keywords: Renin-an- giotensin system blocker; Beta-blocker; Myocardial infarction; Major adverse cardiac even
