Biomedicine: 2022; 42(6): 1178-1184 November - December 2022 DOI: https://doi.org/10.51248/.v42i6.2065 Biomedicine- Vol. 42 No. 6: 2022 Research article Haematological indices in acute coronary syndromes: Could there be a hidden message? Monalisa Biswas 1 , Vijetha Shenoy Belle 1 , Vimal Krishnan S. 2 , Krishnananda Prabhu 1 1 Department of Biochemistry, 2 Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India (Received: September 2022 Revised: October 2022 Accepted: November 2022) Corresponding author: Krishnananda Prabhu. Email: krishnananda.prabhu@manipal.edu ABSTRACT Introduction and Aim: The routine markers of CAD show elevation after the development of acute manifestations. There exists a need for the establishment/validation of biomarkers that predict preclinical atherosclerotic changes. This study assesses the utility of haematological indices in the prediction and prognostication of CAD. Materials and Methods: This retrospective study includes 830 patient reports investigated for serum Troponin T retrieved from the laboratory information system. Reports were grouped into positive and negative categories. Relevant haematological and biochemical data were retrieved. Statistical analysis was carried out to estimate group differences, correlation, sensitivity, specificity, and AUC. Results: Troponin T positive group showed significantly elevated WBCs, neutrophils, CRP, NLR, PLR, and SII with significantly low lymphocytes, monocytes, basophils and RBC count. None of the lipid profile parameters, except serum triglyceride, showed significant differences between groups. Males showed a higher baseline but a blunter elevation CRP during acute coronary events. ROC showed maximum sensitivity (75.9%) and NPV (77.9%) for NLR, while PLR showed maximum specificity (76.4%). Conclusion: Haematological indices may have a better predictive value than conventional lipid profile and might serve as key markers in novel cardiac risk screening panels and aid in the risk stratification and management of coronary artery diseases. Keywords: Coronary artery disease; acute coronary syndromes; inflammation; NLR; PLR; LMR; SII. INTRODUCTION lobally, coronary artery diseases (CAD) account for approximately 17.5 million deaths annually and developing countries contribute to more than 80% of the mortality (1, 2). The current markers of CAD can diagnose atherosclerotic lesions only after it presents as acute coronary syndromes (ACS)/ myocardial infarction (MI) or is incidentally diagnosed through a positive stress test during routine health check-ups (3). The routine markers of CAD, Troponin T and CKMB show elevation after overt development of acute clinical manifestations. Confirmatory diagnosis of CAD involves percutaneous coronary angiogram and the newer CT coronary angiography screening (4). Even though this can forecast the degree and extent of CAD, it cannot be used as a screening tool in the general population. Hence early diagnosis/ risk prediction of CAD remains a complex entity. Atherosclerosis has been redefined as a systemic immune-inflammatory pathology. Typically, coronary artery disease is preceded by a long silent and asymptomatic phase of subclinical inflammation (5). Haematological indices have gained strong interest due to their apparent value in diagnosis, prognosis, and risk stratification of inflammatory conditions. Atherosclerosis is associated with perturbed haematological and inflammatory indices in the peripheral blood (6). Recent studies have explored the utility of haematological ratios like NLR (neutrophil to lymphocyte ratio), PLR (platelets to lymphocyte ratio), LMR (lymphocytes to monocyte ratio) and SII (Systemic Immune Inflammatory Index) for numerous inflammatory diseases. It might be worthwhile to investigate the pattern of haematological perturbations within and between genders to gain a deeper understanding of the pathophysiology which makes males more susceptible to CAD and the gender-specific warning signals of atherosclerotic progression in vulnerable individuals. Hence the present study aims to compare the above indices with conventional cardiac markers between patients with and without MI to obtain a deeper understanding of their roles in the pathophysiology of CAD. MATERIALS AND METHODS This retrospective study was carried out in the Department of Biochemistry after approval from the Institutional Ethical Committee (IEC No 825/2019). Reports/Patients The laboratory information system of the clinical biochemistry laboratory was employed to extract high G 1178