Hematological Indices as a Diagnostic and Prognostic Biomarkers of Acute Coronary Syndrome

Abstract

Background: Acute coronary syndrome (ACS) is a typical coronary artery disease and main cause of death and morbidity worldwide. ACS is a general term used to describe an acute myocardial ischemia with or with out myocardila infarction. Several ACS biomarkers are currently accessible for use as diagnostic, prognostic, and risk predictive indicators in clinical settings. Highly sensitive troponin I (hs-cTn) is considered the gold standard among the most widely utilized ACS biomarkers. But it is scarce in basic care settings in low-income countries. In addition to troponins, a number of other biomarkers that represent thrombosis, inflammation, myocardial injury, and alternative routes are being investigated in an effort to enhance the management of ACS. A small number of studies have publicized a higher association between hematological indices and the probability of unfavorable outcomes in ACS patients, due to systemic inflammation and hypoxemia involved in the pathophysiological pathways. Hematological measures have garnered significant attention due to the discovery that myeloid activity is enhanced in ACS. On their own, these metrics might offer insightful information on pathophysiology and risk assessment. In these circumstances, readily accessible tests like complete blood count (CBC) must be looked into as potential prognostic markers in ACS patients. Objectives: The main aim of the present study is to determine the diagnostic and predictive role of hematological indices in patients with ACS. Methods: From May 1, 2022, to October 31, 2023, an institution-based prospective cohort study was carried out at Jimma Medical Center (JMC), in Southwest Ethiopia. Throughout the study period, all patients in succession who fulfilled the requirements for inclusion and were hospitalized in the cardiovascular unit of JMC with confirmed ACS were included. The non-ACS control groups included university staff, patient visitors, patient attendants, and Jimma residents who appeared to be in good health. Age, sex and residence were used to match them. Face-to-face interviews with study participants and the retrieval of patient medical information were used to gather data. CBC and serum biochemical analyses were conducted in accordance with the manufacturers recommended protocols. Epi-data Version 3.1 was used to enter the data after being verified for completeness, and it was subsequently transferred to Stata-SE Version 14 for analysis. Continuous variables were reported as mean (± SD). Fixed values and percentages were used to describe categorical variables. The continuous variables were compared using an ANOVA. The association between hematologic parameters and high-sensitive troponin-I levels was ascertained using Spearman's correlation coefficient. GRACE risk stratification scores were calculated, and multivariate linear regression analysis was used to determine potential predictors. A multilevel mixed-effects logistic regression was used to assess the predictive efficacy of hematological indicators for in-hospital mortality. The prognostic performance of the hematological parameters was evaluated using ROC curve analysis. The accepted cutoff limit for statistical significance was determined to be p < 0.05. Result: The study included 220 individuals: 110 ACS patients and 110 non-ACS controls. From the patients with ACS who participated, over two-thirds were male, 56 (±11) years old on average, and ST-segment elevation myocardial infarction (STEMI) was diagnosed in 99 (90%) of the cases. The red cell distribution width (RDW), mean platelet volume (MPV), white blood cell (WBC) count, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were all xv noticeably higher in the ACS group. In the ACS study group, there was a positive correlation between high sensitive troponin-I levels and the RDW (r = 0.248, p = 0.009) and MPV (r = 0.245, p = 0.009). ACS patients who did not survive had increased MPV, RDW, and monocyte counts. A worsened global registory of acute coronary event (GRACE) risk score was markedly associated with RDW, MPV, and platelet count (r = 0.569 with p < 0.001, r = 0.585 with p < 0.001, and r = 0.400 with p<0.001, respectively). RDW and MPV were revealed to be independently associated factors with worse GRACE risk scores in multivariable linear regression analysis. Intrahospital mortality was independently correlated with RDW (AOR = 1.202 with 95% CI 1.1152 - 1.2961), mean corpuscular volume (MCV) (AOR = 0.897 with 95% CI 0.8152 - 0.9864), and platelet count (AOR = 0.995 with 95% CI 0.9912 - 0.9995). ROC curve analysis was used to assess the predictive accuracy of hematological indicators in short-term mortality. RDW-SD (AUC = 0.737, 95% CI 0.669–0.805, p < 0.001) and MPV (AUC = 0.603, 95% CI 0.518–0.688, p < 0.001) shown the best discriminative ability. Conclusion: This study underlines the significant role of hematological parameters as potential diagnostic and prognostic indicators in ACS patients. Key findings revealed that MPV, RDW, and other hematological indices were significantly higher in ACS patients, especially among non survivors, compared to non-ACS controls. Notably, RDW and MPV showed strong correlations with worse GRACE risk scores and were independently linked with intrahospital death. These outcomes suggest that easily accessible and cost-effective markers, such as those derived from CBC, can provide valuable insights for risk stratification, diagnosis, and prognosis of ACS, particularly in resource-limited settings. Further research is warranted to explore their integration into clinical practice, which may improve patient management and outcomes.