In ACS patients undergoing bifurcation PCI, increased inflammatory burden reflected by NLR and greater coronary complexity are independently associated with target-vessel failure, supporting the use of combined inflammatory and angiographic risk assessment after PCI.
Target-vessel failure occurred in 20.8% of ACS patients treated with bifurcation PCI using a two-stent strategy over a median follow-up of 29 months.
Patients who experienced target-vessel failure had significantly higher neutrophil-to-lymphocyte ratio values compared to those without TVF.
Patients who experienced target-vessel failure had significantly higher SYNTAX scores compared to those without TVF.
Both NLR and SYNTAX score were independently associated with target-vessel failure in multivariable logistic regression analysis.
The study supports combined use of inflammatory and angiographic risk assessment in ACS patients undergoing bifurcation PCI.
This research suggests that in patients with acute coronary syndrome (ACS) who undergo a complex heart procedure called bifurcation percutaneous coronary intervention (PCI) — where two stents are placed at a branching point in a coronary artery — both inflammation levels in the blood and the complexity of the coronary artery disease can predict whether the treated vessel will subsequently fail. The study tracked 106 such patients over a median of about 2.5 years and found that roughly 1 in 5 patients (20.8%) experienced what the researchers called 'target-vessel failure,' meaning the treated vessel caused a cardiac death, heart attack, or needed to be treated again. The key finding is that a simple blood test ratio called the neutrophil-to-lymphocyte ratio (NLR) — which reflects how much systemic inflammation a person has — was independently linked to this risk of vessel failure, as was the SYNTAX score, which measures how complex and severe the coronary artery disease is. Importantly, both of these factors predicted bad outcomes independently of each other, meaning each added unique prognostic information beyond what the other alone could provide. This research suggests that doctors treating ACS patients with complex bifurcation stenting procedures may benefit from looking at both how inflamed a patient is (using the simple NLR blood test taken at admission) and how anatomically complex the coronary disease is (using the SYNTAX score), rather than relying on either measure alone. This combined approach could help identify which patients are at highest risk of future vessel-related problems and may warrant closer follow-up or additional treatment considerations.
Erdöl M, Demirtola A, Yayla &, Yayla K, Ertem A, Akçay A. (2026). Admission neutrophil-to-lymphocyte ratio and target-vessel failure after bifurcation percutaneous coronary intervention in acute coronary syndrome.. Cardiovascular journal of Africa. https://doi.org/10.5830/CVJA-2026-035