Inflammation
High neutrophil-to-lymphocyte ratio unmasks Lp(a)'s prognostic harm after PCI, especially in women, 7,922-patient study finds (Angiology 2025)
Original title: The Neutrophil to Lymphocyte Ratio Modifies Lipoprotein (a)-Related Poor Prognosis in Patients After Percutaneous Coronary Intervention
This study enrolled 7,922 consecutive coronary artery disease patients undergoing percutaneous coronary intervention (PCI) to test whether the neutrophil-to-lymphocyte ratio (NLR), an inflammatory biomarker, modifies Lp(a)'s prognostic association, using a median NLR cutoff of 2.07 and an Lp(a) threshold of 30 mg/dL. Over 2 years of follow-up, 111 patients (1.40%) had a major adverse cardiac event (MACE). Lp(a) above 30 mg/dL was associated with higher MACE risk only in patients with NLR at or above 2.07 (adjusted HR 1.84, 95% CI 1.12-3.03), not in those with lower NLR (adjusted HR 0.74, 95% CI 0.38-1.45), a significant interaction (P for interaction = 0.021). This synergistic Lp(a)-NLR association with prognosis was more pronounced in female patients (P for interaction = 0.028). The authors suggest combining Lp(a) with NLR, a cheap and widely available inflammatory marker, could refine post-PCI risk stratification.
Original abstract
Lipoprotein (a) [Lp(a)] could contribute to coronary artery disease (CAD) through proinflammatory effects. The neutrophil to lymphocyte ratio (NLR) is an inflammatory biomarker. We consecutively enrolled 7,922 CAD patients to investigate the synergistic association of Lp(a) and NLR with prognosis in patients undergoing percutaneous coronary intervention (PCI). NLR was calculated as the neutrophil count divided by the lymphocyte count. Cutoff for NLR was a median of 2.07. The threshold value was set at 30 mg/dL for Lp(a). The primary endpoint was major adverse cardiac events (MACEs), including all-cause mortality and myocardial infarction. During 2 years follow-up, 111 (1.40%) MACEs occurred. Lp(a) > 30 mg/dL was associated with an increased MACE risk in participants with NLR ≥2.07 [adjusted hazard ratio (HR), 1.84; 95% CI, 1.12-3.03], but not in participants with NLR <2.07 (adjusted HR, 0.74; 95% CI, 0.38-1.45) (Pinteraction = 0.021). Subgroup analysis demonstrated that the synergistic association of Lp(a) and NLR with prognosis was more pronounced in female patients (Pinteraction = 0.028). This study suggested that combining Lp(a) and NLR may be useful for risk stratification in CAD population.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.