DOI: https://doi.org/10.53350/pjmhs20221612307 ORIGINAL ARTICLE P J M H S Vol. 16, No. 12, December, 2022 307 Relationship of Neutrophil to Lymphocytis Ratio with Success of Thrombolysis in Patients of STEMI ASMA KAMAL 1 , SHAZIA SIDDIQUE 2 , KHADIJA MUNEER 3 , ASIFA KAMAL 4 , MAHRUKH MANSOOR KHOSA 5 , ANEEQA ILYAS 6 1 Assistant Professor of Medicine, Services Institute of Medical Sciences/Services Hospital, Lahore 2 MBBS, FCPS (Medicine), Jinnah Hospital LHR 3 MBBS, FCPS (Medicine), SHL 4 Associate Professor Statistics LCWU 5 MBBS, FCPS, (Cardiology), MO PIC LHR 6 MBBS, FCPS (Medicine), SHL Correspondence to: Asma Kamal, Email: drasmakamal@gmail.com, Cell: 0336-4154436 ABSTRACT Objectives: To determine the frequency of success of thrombolysis using SK in patients of STEMI, To investigate the association of success of thrombolysis with NLR in patients of STEMI. Methodology: A descriptive cross sectional study was carried out at Coronary Care Unit (CCU) of Services Hospital, Lahore. The sample size of 130 patients were enrolled by non-probability consecutive sampling. In this study all male and female patients from 25 to 100 years of age with STEMI who were given SK were included from CCU of Services Hospital, Lahore using non probability consecutive sampling. NLR was calculated. Success of thrombolytic therapy was determined by relief of chest pain & resolution of ≥ 50% ST-elevations (STE) in ECG taken 90 minutes after completion of SK. Results: In this study, there were total 130 cases and out of these 72 (55.38%) were males and 58 (44.62%) were females. High NLR was seen in 43 (33.08%) of the cases. Successful thrombolysis was observed in 99 (76.15%) of the cases. Successful thrombolysis was observed in 29 (67.44%) cases with high NLR and 70 (80.46%) cases with low. There was no significant association of NLR, BMI, smoking, DM and HTN with successful thrombolysis. Practical Implication of this Study: is that in our resource limited country NLR is one of cheapest test to access severity and prognosis so patients with high NLR can be reffered early for intervention even if responded successfully to thrombolysis as complications of STEMI are frequent in high NLR patients as compared to lower NLR. Conclusion: Successful thrombolysis was seen in almost 3/4 cases in acute STEMI. Although a cheaper and readily available prognostic tool, no statistically significant association was found in terms of the admission NLR and the success of thrombolysis. Moreover, there was no significant association in terms of any of the confounders of the study. Keywords: Thrombolysis, Streptokinase (SK), Neutrophil to Lymphocytis Ratio (NLR), ST Segment Elevation MI (STEMI) INTRODUCTION Myocardial infarction (MI) results from rupture of atheromatous plaque and thrombosis in an epicardial vessels leading to imbalance in demand and supply of oxygen to Myocardium. 1 Pathophisiologically myocardial infarction is irreversible myocardial cell death resulting from ischaemia that is biochemically supported via cardiac enzymes, ECG changes, to detect myocardial injury and necrosis. The atheromatous plaque starts with thickening of arterial intima without or minimal inflammation of cells and this can be observed shortly after birth. Afterward lipid rich necrotic core surrounded through fibrous tissue is formed. Finally vulnerable plaque consists of necrotic core with thin fiborous cap deficient in smooth muscles and infiltrated with inflammatory cells is found. 2,3 The mortality rate in myocardial infarction is 30% and half of deaths occur before arrival in the hospital. Other 5% to10% die within 1 st year after MI and half are re-hospitalized within 1 st year of MI. The Prognosis of MI depends on extent of infarct, residual left ventricle function whether patient underwent revascularization. The incidence of Coronary Artery Disease (CAD) related mortality is projected to rise dramatically in developing countries including India, Middle East, Latin America and Sub-Saharan Africa with approximately 80 percent increase from 1990’s to 2020’s. 4,5 A significant reperfusion approach is fibrinolysis, particularly, where primary PCI can’t be offered within timelines. Benefit of fibrinolytic therapy in patients with STEMI is well established. Largest benefit seen when administered within 12 hours after the symptomatic onset and in patients with highest cardiovascular risk. 6,7 Atherosclerosis is a multifactorial disease. And there is role of inflammation in formation and developmkent of atherosclerotic plaque. Two inflammatory markers, neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width (RDW) are used to find out risk of mortality plus adverse cardiovascular outcomes in patients having acute myocardial infarction. In cardiovascular disease, White blood cell count and its subtypes are considered to be classic markers of inflammation. NLR was considered to be a inflammatory marker in cardiac and non-cardiac diseases too. So, it is used as predictor of long term mortality in patients undergoing PCI in STEMI. 8 As neutrophil and lymphocyte values are readily available in routine blood count analysis, So NLR may be used as cost effective predictor of cardiovascular complications and inflammation. MATERIALS AND METHODS A descriptive cross sectional study was carried out at Coronary Care Unit (CCU) of Services Hospital, Lahore. The sample size of 130 patients was calculated with 8% margin of error and 95% confidence level. All the patients were enrolled by non-probability consecutive sampling. In this study all male and female patients from 25 to 100 years of age with STEMI who were given SK were included from CCU of Services Hospital, Lahore using non probability consecutive sampling. NLR was calculated. Success of thrombolytic therapy was determined by relief of chest pain & resolution of ≥ 50% ST-elevations (STE) in ECG taken 90 minutes after completion of SK. All the data was collected on the predesigned performa. Data was entered and analyzed by using SPSS 25.0. all the quantitative variables were presented by mean+SD and qualitative with frequencies and percentages. Association between success of thrombosis and risk factors were analyzed by using Chi-square test. P-value <0.05 was considered as significant. Statistical Technique: Descriptive Statistics, Chi Square Test RESULTS The study shows that there were total 130 cases and out of these 72 (55.38%) were males and 58 (44.62%) were females. Success of thrombolysis was observed in 99 (76.15%) of the cases (Figure 1).High NLR was seen in 43 (33.08%) and low NLR in 87 (66.92%) of the cases (Figure 2).