Diagnostic Accuracy of Platelet/Lymphocyte Ratio for Screening Complex Coronary Lesion in Different Age Group of Patients with Acute Coronary Syndrome

Irma Wahyuni Anwar, Ika Prasetya Wijaya, Lugyanti Sukrisman, Sally A Nasution, Cleopas M Rumende


Background: with the increasing number of patients with acute coronary syndrome (ACS) with complex coronary lesion and the increasing needs of coronary artery bypass grafting (CABG) procedures, there is an increasing need for a tool to perform early stratification in high-risk patients, which can be used in daily clinical practice, even at first-line health care facilities setting in Indonesia. It is expected that early stratification of high-risk patients can reduce morbidity and mortality rate in patients with ACS. This study aimed to identify diagnostic accuracy of platelet/lymphocyte ratio (PLR) and the optimum cut-off point of PLR as a screening tool for identifying a complex coronary lesion in patients ?45 and >45 years old. Methods: this was a retrospective cross-sectional study, conducted at the ICCU of Cipto Mangunkusumo Hospital. Data was obtained from medical records of adult patients with ACS who underwent coronary angiography between January 2012 - July 2015. The inclusion criteria were adult ACS patients (aged ?18 years old), diagnosed with ACS and underwent coronary angiography during hospitalization. Diagnostic accuracy was determined by calculating sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-). The cut-off point was determined using ROC curve. Results: the proportion of ACS patients with complex coronary lesion in our study was 47.2%. The optimum cut-off point in patients aged ?45 years was 111.06 with sensitivity, specificity, LR+ and LR of 91.3%, 91.9%, 11.27 and 0.09, respectively. The optimum cut-off points in patients aged >45 years was 104.78 with sensitivity, specificity, LR+ and LR of 91.7%, 58.6%, 2.21 and 0.14, respectively. Conclusion: the optimum cut-off point for PLR in patients aged ? 45 years is 111.06 and for patients with age >45 years is 104.78 with diagnostic accuracy, represented by AUC of 93.9% (p<0.001) and 77.3% (p<0.001), respectively for both age groups.


PLR; complex coronary lesion; Gensini score; acute coronary syndrome


World health organization: Global burden disease 2014. [cited 2015 July 15]. Available at: http://apps.who.int/countries/edn/en/en/

Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. Pedoman dan tatalaksana sindrom koroner akut. 2015.

Riset Kesehatan Dasar. Departemen kesehatan republik Indonesia: Riset kesehatan dasar (RISKESDAS). 2013.

Setyawan W. Validasi skor TIMI dalam memprediksi mortalitas pasien sindrom koroner akut di Indonesia. Jakarta: Universitas Indonesia; 2011.

Kumar B, Zein A, Wahyuni I, Nasution SA. Profil luaran klinis selama perawatan pada pasien sindrom koroner akut di intesive coronary care unit, RSUPN Cipto Mangunkusumo, sebuah studi pendahuluan. Jakarta: Departemen Ilmu Penyakit Dalam, FKUI IPD; 2015.

Ugur M, Gul M, Bozbay M, et al. The relationship between platelet to lymphocyte ratio and the clinical outcomes in ST elevation myocardial infarction underwent primary coronary intervention. Blood Coagul Fibrinolysis. 2014;25(8):806-11.

Trip MD, Cats VM, van Capelle FJ, Vreeken J. Platelet hyperreactivity and prognosis in survivors of myocardial infarction. N Engl J Med. 1990;322(22):1549-54.

Teixeira M, Sa I, Mendes JS, Martins L. Acute coronary syndrome in young adults. Rev Port Cardiol. 2010;29(6):947-55.

Al-Murayeh MA, Al-Masswary AA, Dardir MD, et al. Clinical presentation and short-term outcome of acute coronary syndrome in native young saudi population. J Saudi Heart Assoc. 2012;24(3):169-75.

Setianto BY, Sari J, Hartopo AB, Ra Gharini PP. Acute coronary syndrome in young patients at Sardjito Hospital. Acta Interna. 2014;4:23-8.

Isnanta R, Panggabean MM, Alwi I. Comparison of coronary angiography characteristics among acute coronary syndrome patients in young and old age patients at Cipto Mangunkusumo Hospital Jakarta. Acta Med Indones. 2014;46(2):117-23.

Furman MI, Benoit SE, Barnard MR, et al. Increased platelet reactivity and circulating monocyte-platelet aggregates in patients with stable coronary artery disease. J Am Coll Cardiol. 1998;31(2):352-8.

Gotsman I, Stabholz A, Planer D, et al. Serum cytokine tumor necrosis factor-alpha and interleukin-6 associated with the severity of coronary artery disease: Indicators of an active inflammatory burden? Isr Med Assoc J. 2008;10(7):494-8.

Shi Y, Wu Y, Bian C, et al. Predictive value of plasma fibrinogen levels in patients admitted for acute coronary syndrome. Tex Heart Inst J. 2010;37(2):178-83.

McDermott MM, Guralnik JM, Corsi A, et al. Patterns of inflammation associated with peripheral arterial disease: The inchianti study. Am Heart J. 2005;150(2):276-81.

Azab B, Shah N, Akerman M, McGinn JT, Jr. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-st-elevation myocardial infarction. J Thromb Thrombolysis. 2012;34(3):326-34.

Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2014:1-2.

Hudzik B, Szkodzinski J, Gorol J, et al. Platelet-to-lymphocyte ratio is a marker of poor prognosis in patients with diabetes mellitus and st-elevation myocardial infarction. Biomark Med. 2015;9(3):199-207.

Oylumlu M, Yildiz A, Oylumlu M, et al. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anatol J Cardiol. 2015;15(4):277-83.

Temiz A, Gazi E, Gungor O, et al. Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction. Med Sci Monit. 2014;20:660-5.

Guo C, Zhang S, Zhang J, et al. Correlation between the severity of coronary artery lesions and levels of estrogen, hs-crp and mmp-9. Exp Ther Med. 2014;7(5):1177-80.

Sinning C, Lillpopp L, Applebaum S, et al. Angiographic score assessment improves cardiovascular risk prediction: The clinical value os syntax and gensini application. Clin Res Cardiol. 2013;102(7):495-503.

Neeland IJ, Patel RS, Eshtehardi P, et al. Coronary angiographic scoring systems: An evaluation of their equivalence and validity. Am Heart J. 2012; 164(4):547-52.

Ayca B, Akin F, Celik O, et al. Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention. Platelets. 2014:1-7.

Kurtul A, Murat SN, Yarlioglues M, et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am J Cardiol. 2014;114(7):972-8.

Sari I, Sunbul M, Mammadov C, et al. Relation of neutrophil to lymphocyte and platelet to lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography. Kardiol Pol. 2015:1-13.

Akboga MK, Canpolat U, Yayla C, et al. Association of platelet to lymphocyte ratio with inflammation and severity of coronary atherosclerosis in patients with stable coronary artery disease. Angiology. 2015:1-7.

Wolk R, Berger P, Lennon RJ, Brilakis ES, Somers VK. Body mass index: A risk factor for unstable angina and myocardial infarction in patients with angiographically confirmed coronary artery disease. Circulation. 2003;108(18):2206-11.

Inoue T, Oku K, Kimoto K, et al. Relationship of cigarette smoking to the severity of coronary and thoracic aortic atherosclerosis. Cardiology. 1995;86(5):374-9.

Tungsubutra W, Tresukosol D, Buddhari W, et al. Acute coronary syndrome in young adults: the Thai ACS registry. J Med Assoc Thai. 2007;90 Suppl 1:81-90.

Full Text: PDF


  • There are currently no refbacks.