White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome

Leukocyte and platelet have been found to be associated with metabolic syndrome (MetS). We aimed to
determine the usefulness of a novel marker named white blood cell count to mean platelet volume ratio (WMR) for predicting outcomes
of non-ST elevation acute coronary syndrome (NSTE-ACS) with or without MetS.
Subjects and Methods: A total of 331 NSTE-ACS individuals (60±12.5 years, 57.4% male) were enrolled and followed for a median of 24
months. MetS was identified using the National Cholesterol Education Program Adult Treatment Panel III criteria.
Results: Patients were divided into two groups: high WMR (WMR≥720) and low WMR (WMR<720). Major adverse cardiovascular events
(MACE) and MetS rates were significantly greater in the higher WMR group compared to those in the low WMR group (MACE: 14.3% vs.
25%, p=0.014; MetS: 50.9% vs. 75%, p<0.001). MetS was diagnosed in 62.2% of patients. MACE incidence in patients with or without
MetS was comparable (p=0.737). Among MetS individuals, patients in the high WMR group had more MACE than the low WMR group
(11.2% vs. 26.5%, p=0.007). However, MACE was comparable among non-MetS individuals (p=0.681). In multivariable Cox regression
analysis, hazard ratios (HR) of MACE incidence for high-WMR in MetS individuals was 2.616 (95% confidence interval: 1.282–5.339,
p=0.008). However, HR of MACE incidence for high WMR in non-MetS individuals was not significant.
Conclusion: Among NSTE-ACS patients without revascularization therapy, elevated admission WMR was associated with an increased risk
of developing composite MACE in MetS individuals but not in non-MetS patients