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:: Volume 34, Issue 4 (9-2026) ::
Journal of Ilam University of Medical Sciences 2026, 34(4): 74-86 Back to browse issues page
Relationship Between the Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio with the Severity of Acute Coronary Syndrome in Ilam
Sajjad Monghad Monfared1 , Aliashraf Mozafari2 , Yousef Mohamadi *3 , Abbas Soleimani4
1- School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
2- Dept of Epidemiology, School of Health, Ilam University of Medical Sciences, Ilam, Iran
3- Dept of Anatomy, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran , yosefmohamadi1365@gmail.com
4- Dept of Cardiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
Abstract:   (253 Views)
Introduction:  Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio are simple and cost-effective inflammatory biomarkers, reflecting systemic inflammation, and play an important role in the pathophysiology of acute coronary syndrome. The aim of this study was to investigate the relationship between these markers and the severity of this disease in Ilam, Iran.
Materials & Methods: This cross-sectional study was conducted on 130 patients with acute coronary syndrome hospitalized in Mustafa Khomeini Hospital of Ilam. Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and severity of acute coronary syndrome were collected from patients' electronic medical records system. Severity of the syndrome was classified into three types: unstable angina, myocardial infarction with ST-segment elevation, and myocardial infarction without ST-segment elevation. Data analysis was performed using t-test, ANOVA, Kruskal-Wallis, Mann-Whitney, and nominal logistic regression in SPSS version 16.
Results: The mean of the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio was significantly different in patients with different severities of acute coronary syndrome, such that high values of the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were significantly associated with the severity of acute coronary syndrome (p < 0.05). In addition, increasing neutrophil-to-lymphocyte ratio increased the risk of acute coronary syndrome in patients with ST-elevation myocardial infarction and myocardial infarction without ST-elevation compared to patients with unstable angina (p < 0.05).
Conclusion: High PLR and NLR were found to be associated with the severity of ACS in this study and reflect the inflammatory and thrombotic processes. Increased NLR was significantly associated with a greater risk of both STE-ACS and non-STE-ACS. Smoking and older age were also significant risk factors. PLR and NLR may be simple biomarkers for ACS risk stratification but need to be confirmed by larger prospective studies.

 
Keywords: Acute coronary syndrome, platelet, neutrophil, lymphocyte
Full-Text [PDF 870 kb]   (111 Downloads)    
Editorial Note: Research | Subject: Clinical pathology
Received: 2026/05/31 | Accepted: 2026/06/22 | Published: 2026/09/27
References
1. Oylumlu M, Yıldız A, Oylumlu M, Yüksel M, Polat N, Bilik MZ, et al. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anatol J Cardiol. 2015;15:277-83. doi: 10.5152/akd.2014.5366.
2. Xu R, Chen L, Yan C, Xu H, Cao G. Elevated platelet‐to‐lymphocyte ratio as a predictor of all‐cause and cardiovascular mortality in hypertensive individuals. J Clin Hypertens (Greenwich). 2025;27:e14980.
3. Park JJ, Jang HJ, Oh IY, Yoon CH, Suh JW, Cho YS, et al. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol. 2013;111:636-42. doi: 10.1016/j.amjcard.2012.11.012.
4. Pruc M, Peacock FW, Rafique Z, Swieczkowski D, Kurek K, Tomaszewska M, et al. The Prognostic Role of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis. J Clin Med. 2023;12. doi: 10.3390/jcm12216903.
5. Zhang Y, Zhang A, Wei L, Ren K, Wang Q, Shao B, et al. A high platelet-to-lymphocyte ratio predicts all-cause mortality and cardiovascular mortality in maintenance hemodialysis patients. Ren Fail. 2023;45:2258228. doi: 10.1080/0886022X.2023.2258228.
6. Ye GL, Chen Q, Chen X, Liu YY, Yin TT, Meng QH, et al. The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: A cohort study. Sci Rep. 2019;9:10639. doi: 10.1038/s41598-019-47143-2.
7. Wang H, Li L, Ma Y. Platelet-to-lymphocyte ratio a potential prognosticator in acute myocardial infarction: A prospective longitudinal study. Clin Cardiol. 2023;46:632-8. doi: 10.1002/clc.24002.
8. Soylu K, Gedikli Ö, Dagasan G, Aydin E, Aksan G, Nar G, et al. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome. Rev Port Cardiol. 2015;34:465-71. doi: 10.1016/j.repc.2015.01.013.
9. Ismail MA, abdel Rady Metawaa MA, Farouk MM, Mohamed Salah LT. The Role of Neutrophil to Lymphocyte Ratio and Platelet Indices as Markers of Inflammation in Acute Coronary Syndrome. QJM: Int J Med. 2024;117. doi:10.1093/qjmed/hcae175.184.
10. Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem. 2018;52:131-6. doi: 10.1016/j.clinbiochem.2017.11.008.
11. Suliman MARM, Juma AAB, Almadhani AAA, Pathare AV, Alkindi SSA, Werner FU. Predictive value of neutrophil to lymphocyte ratio in outcomes of patients with acute coronary syndrome. Arch Med Res. 2010;41:618-22. doi: 10.1016/j.arcmed.2010.11.006.
12. Nohria R, Viera AJ. Acute Coronary Syndrome: diagnosis and initial management. Am Fam Physician. 2024;109:34-42.
13. Gao Y, Li Y, Chen X, Wu C, Guo Z, Bai G, et al. The Systemic Inflammation Index Predicts Poor Clinical Prognosis in Patients with Initially Diagnosed Acute Coronary Syndrome Undergoing Primary Coronary Angiography. J Inflamm Res. 2023;16:5205-19. doi: 10.2147/JIR.S435398.
14. Ertürk M, Caglar FNT, Bıyık İ, Işıksaçan N, Yazan S, Yıldırım MR, et al. Correlations between hematological indicators and other known markers in acute coronary syndromes. JUCVM. 2017; 5: 67-74. doi: 10.15511/ejcm.17.00467.
15. Shahabirabori V, Shahabirabori R, Hatami Y, Hajizadeh R, Rahimi B. Relationship of Peripheral Blood Platelet to Lymphocyte Ratio with the Severity of Coronary Disease in Patients with Acute Coronary Syndrome in Taleghani Hospital, Urmia, Iran. J Ilam Univ Med Sci. 2021;29:30-8.
16. AlHammouri HM, Mustafa O, Mash'al N, Suwan S, Al‐Rababa'h M, Turk AZ, et al. Inflammatory Markers and Contrast‐Induced Nephropathy Risk: A Meta‐Analysis of NLR and PLR in ACS Patients Undergoing Percutaneous Coronary Intervention. Catheter Cardiovasc Interv. 2025; 106:2361-2373. doi: 10.1002/ccd.70056.
17. Pruc M, Kubica J, Banach M, Swieczkowski D, Rafique Z, Peacock WF, et al. Diagnostic and prognostic performance of the neutrophil-to-lymphocyte ratio in acute coronary syndromes: A meta-analysis of 90 studies including 45 990 patients. Kardiol Pol. 2024;82:276-84. doi: 10.33963/v.phj.99554.
18. Ghasempour Dabaghi G, Rabiee Rad M, Mortaheb M, Darouei B, Amani-Beni R, Mazaheri-Tehrani S, et al. The Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Outcomes in Patients With Diabetes: A Systematic Review and Meta-Analysis. Cardiol Rev. 2025;33:202-11. doi: 10.1097/CRD.0000000000000820.
19. Zengin A, Karaca M, Aruğaslan E, Yıldırım E, Karataş MB, Çanga Y, et al. Performance of neutrophil to lymphocyte ratio for the prediction of long-term morbidity and mortality in coronary slow flow phenomenon patients presented with non-ST segment elevation acute coronary syndrome. J Cardiovasc Thorac Res. 2021;13:125. doi: 10.34172/jcvtr.2021.12.
20. Lao M, Liu H, Cai X, Zhang Y, Liu T, Li G, et al. The Monocyte-to-Lymphocyte Ratio Exhibits A Superior Prognostic Value in Patients with Newly Diagnosed Acute Coronary Syndrome. Rev Cardiovasc Med. 2025; 26:39917. doi: 10.31083/RCM39917.
21. Kofos C, Papazoglou AS, Fyntanidou B, Samaras A, Stachteas P, Nasoufidou A, et al. Platelet-to-Lymphocyte and Glucose-to-Lymphocyte Ratios as Prognostic Markers in Hospitalized Patients with Acute Coronary Syndrome. J Cardiovasc Dev Dis. 2025; 12:334. doi: 10.3390/jcdd12090334.
22. Wang H, Zulikaier T, Yumaierjiang B, Lyu S, He PJRiCM. Platelet-to-lymphocyte ratio efficiency in predicting major adverse cardiovascular events after percutaneous coronary intervention in acute coronary syndromes: a meta-analysis. Rev Cardiovasc Med. 2025;26:27942. doi: 10.31083/RCM27942.
23. Khawaldeh BMH, Ameer F, Al-Hawadi BS, Alhawadi SS, Ali AOH, Eltamawy KMA, et al. prognostic value of neutrophil-to-lymphocyte ratio in cardiovascular disease: a systematic review and meta-analysis. Gland Surg. 2026;11:41-57.
24. Oylumlu M, Yıldız A, Oylumlu M, Yüksel M, Polat N, Bilik MZ, et al. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anatol J Cardiol. 2015;15:277-83. doi: 10.5152/akd.2014.5366.
25. Xu R, Chen L, Yan C, Xu H, Cao G. Elevated platelet‐to‐lymphocyte ratio as a predictor of all‐cause and cardiovascular mortality in hypertensive individuals. J Clin Hypertens (Greenwich). 2025;27:e14980.
26. Park JJ, Jang HJ, Oh IY, Yoon CH, Suh JW, Cho YS, et al. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol. 2013;111:636-42. doi: 10.1016/j.amjcard.2012.11.012.
27. Pruc M, Peacock FW, Rafique Z, Swieczkowski D, Kurek K, Tomaszewska M, et al. The Prognostic Role of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis. J Clin Med. 2023;12. doi: 10.3390/jcm12216903.
28. Zhang Y, Zhang A, Wei L, Ren K, Wang Q, Shao B, et al. A high platelet-to-lymphocyte ratio predicts all-cause mortality and cardiovascular mortality in maintenance hemodialysis patients. Ren Fail. 2023;45:2258228. doi: 10.1080/0886022X.2023.2258228.
29. Ye GL, Chen Q, Chen X, Liu YY, Yin TT, Meng QH, et al. The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: A cohort study. Sci Rep. 2019;9:10639. doi: 10.1038/s41598-019-47143-2.
30. Wang H, Li L, Ma Y. Platelet-to-lymphocyte ratio a potential prognosticator in acute myocardial infarction: A prospective longitudinal study. Clin Cardiol. 2023;46:632-8. doi: 10.1002/clc.24002.
31. Soylu K, Gedikli Ö, Dagasan G, Aydin E, Aksan G, Nar G, et al. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome. Rev Port Cardiol. 2015;34:465-71. doi: 10.1016/j.repc.2015.01.013.
32. Ismail MA, abdel Rady Metawaa MA, Farouk MM, Mohamed Salah LT. The Role of Neutrophil to Lymphocyte Ratio and Platelet Indices as Markers of Inflammation in Acute Coronary Syndrome. QJM: Int J Med. 2024;117. doi:10.1093/qjmed/hcae175.184.
33. Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem. 2018;52:131-6. doi: 10.1016/j.clinbiochem.2017.11.008.
34. Suliman MARM, Juma AAB, Almadhani AAA, Pathare AV, Alkindi SSA, Werner FU. Predictive value of neutrophil to lymphocyte ratio in outcomes of patients with acute coronary syndrome. Arch Med Res. 2010;41:618-22. doi: 10.1016/j.arcmed.2010.11.006.
35. Nohria R, Viera AJ. Acute Coronary Syndrome: diagnosis and initial management. Am Fam Physician. 2024;109:34-42.
36. Gao Y, Li Y, Chen X, Wu C, Guo Z, Bai G, et al. The Systemic Inflammation Index Predicts Poor Clinical Prognosis in Patients with Initially Diagnosed Acute Coronary Syndrome Undergoing Primary Coronary Angiography. J Inflamm Res. 2023;16:5205-19. doi: 10.2147/JIR.S435398.
37. Ertürk M, Caglar FNT, Bıyık İ, Işıksaçan N, Yazan S, Yıldırım MR, et al. Correlations between hematological indicators and other known markers in acute coronary syndromes. JUCVM. 2017; 5: 67-74. doi: 10.15511/ejcm.17.00467.
38. Shahabirabori V, Shahabirabori R, Hatami Y, Hajizadeh R, Rahimi B. Relationship of Peripheral Blood Platelet to Lymphocyte Ratio with the Severity of Coronary Disease in Patients with Acute Coronary Syndrome in Taleghani Hospital, Urmia, Iran. J Ilam Univ Med Sci. 2021;29:30-8.
39. AlHammouri HM, Mustafa O, Mash'al N, Suwan S, Al‐Rababa'h M, Turk AZ, et al. Inflammatory Markers and Contrast‐Induced Nephropathy Risk: A Meta‐Analysis of NLR and PLR in ACS Patients Undergoing Percutaneous Coronary Intervention. Catheter Cardiovasc Interv. 2025; 106:2361-2373. doi: 10.1002/ccd.70056.
40. Pruc M, Kubica J, Banach M, Swieczkowski D, Rafique Z, Peacock WF, et al. Diagnostic and prognostic performance of the neutrophil-to-lymphocyte ratio in acute coronary syndromes: A meta-analysis of 90 studies including 45 990 patients. Kardiol Pol. 2024;82:276-84. doi: 10.33963/v.phj.99554.
41. Ghasempour Dabaghi G, Rabiee Rad M, Mortaheb M, Darouei B, Amani-Beni R, Mazaheri-Tehrani S, et al. The Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Outcomes in Patients With Diabetes: A Systematic Review and Meta-Analysis. Cardiol Rev. 2025;33:202-11. doi: 10.1097/CRD.0000000000000820.
42. Zengin A, Karaca M, Aruğaslan E, Yıldırım E, Karataş MB, Çanga Y, et al. Performance of neutrophil to lymphocyte ratio for the prediction of long-term morbidity and mortality in coronary slow flow phenomenon patients presented with non-ST segment elevation acute coronary syndrome. J Cardiovasc Thorac Res. 2021;13:125. doi: 10.34172/jcvtr.2021.12.
43. Lao M, Liu H, Cai X, Zhang Y, Liu T, Li G, et al. The Monocyte-to-Lymphocyte Ratio Exhibits A Superior Prognostic Value in Patients with Newly Diagnosed Acute Coronary Syndrome. Rev Cardiovasc Med. 2025; 26:39917. doi: 10.31083/RCM39917.
44. Kofos C, Papazoglou AS, Fyntanidou B, Samaras A, Stachteas P, Nasoufidou A, et al. Platelet-to-Lymphocyte and Glucose-to-Lymphocyte Ratios as Prognostic Markers in Hospitalized Patients with Acute Coronary Syndrome. J Cardiovasc Dev Dis. 2025; 12:334. doi: 10.3390/jcdd12090334.
45. Wang H, Zulikaier T, Yumaierjiang B, Lyu S, He PJRiCM. Platelet-to-lymphocyte ratio efficiency in predicting major adverse cardiovascular events after percutaneous coronary intervention in acute coronary syndromes: a meta-analysis. Rev Cardiovasc Med. 2025;26:27942. doi: 10.31083/RCM27942.
46. Khawaldeh BMH, Ameer F, Al-Hawadi BS, Alhawadi SS, Ali AOH, Eltamawy KMA, et al. prognostic value of neutrophil-to-lymphocyte ratio in cardiovascular disease: a systematic review and meta-analysis. Gland Surg. 2026;11:41-57.
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Monghad Monfared S, Mozafari A, Mohamadi Y, Soleimani A. Relationship Between the Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio with the Severity of Acute Coronary Syndrome in Ilam. J. Ilam Uni. Med. Sci. 2026; 34 (4) :74-86
URL: http://sjimu.medilam.ac.ir/article-1-8955-en.html
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Volume 34, Issue 4 (9-2026) Back to browse issues page
مجله دانشگاه علوم پزشکی ایلام Journal of Ilam University of Medical Sciences
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