Platelet-to-white-cell ratio at admission was associated with long-term mortality in patients with acute myocardial infarction, suggesting it may support individualized risk stratification and clinical decision-making in AMI care.
Key Findings
Results
Platelet-to-white-cell ratio (PWR) quartiles were associated with long-term all-cause mortality in acute myocardial infarction patients.
Multivariable adjusted HRs for the second, third, and fourth quartiles of PWR (vs. lowest quartile) were 0.64 (95% CI: 0.52–0.80), 0.83 (0.67–1.03), and 0.78 (0.62–0.98), respectively.
The second quartile showed the strongest inverse association with mortality compared to the lowest quartile.
The third quartile HR was not statistically significant (95% CI crossed 1.0), while the second and fourth quartiles were statistically significant.
PWR was calculated from admission platelets divided by leukocyte counts.
Results
High platelet count (highest quartile) was associated with increased mortality risk in AMI patients.
HR for highest quartile of platelet count vs. reference was 1.32 (95% CI: 1.06–1.63).
This association was observed after multivariable adjustment.
Platelet count alone was evaluated alongside leukocyte count and PWR as separate predictors.
Methods
The study population included 4,964 AMI patients from a population-based registry, with 1,224 deaths occurring during follow-up.
Patients were aged 25–84 years with incident acute myocardial infarction hospitalized between 2010 and 2017.
Data were drawn from the population-based Augsburg Myocardial Infarction Register.
Median follow-up time was 4.7 years.
1,224 patients died during the follow-up period, representing approximately 24.7% of the cohort.
Methods
Cox proportional hazards regression models were used to assess associations between quartiles of PWR, leukocytes, and platelets with long-term all-cause mortality.
Quartile-based analyses were performed for PWR, leukocyte counts, and platelet counts separately.
Models were multivariable adjusted.
The lowest quartile served as the reference group for all comparisons.
Conclusions
PWR is described as a simple, cost-effective biomarker that may support individualized risk stratification in AMI care.
PWR is derived from routinely collected admission blood count values (platelets and leukocytes).
The authors highlight its potential for 'individualized risk stratification and clinical decision-making in acute myocardial infarction care.'
The study compared PWR to leukocyte and platelet counts alone as prognostic indicators.
What This Means
This research examined whether a simple blood test ratio — the number of platelets divided by the number of white blood cells (called the platelet-to-white-cell ratio, or PWR) — measured at hospital admission could predict long-term survival in people who had a heart attack. The study followed nearly 5,000 heart attack patients from a German regional registry for a median of about 4.7 years, during which roughly 1 in 4 patients died. The researchers found that patients with very low PWR values at admission had the highest risk of dying, while those in the second-lowest quartile had about 36% lower risk compared to that lowest group. Those with the highest platelet counts (regardless of white cell count) also had a notably higher death risk.
This research suggests that combining platelet and white blood cell counts into a single ratio may provide more prognostic information than looking at either measure alone. Because both values are routinely collected during a standard blood test at hospital admission, calculating the PWR costs nothing extra and requires no additional procedures. This makes it a potentially practical tool for doctors to quickly identify heart attack patients who may be at higher risk of dying in the years following their hospitalization.
The findings are meaningful because better risk stratification at the time of hospital admission could help medical teams tailor the intensity of monitoring and treatment to individual patients. However, as an observational registry study, this research identifies associations rather than causes, and further studies would be needed to confirm how PWR should be incorporated into clinical practice alongside other established risk factors.
Kraus M, Schmitz T, Raake P, Linseisen J, Meisinger C. (2026). Evaluation of the platelet-to-white-cell ratio (PWR) as predictor of long-term all-cause mortality in patients with acute myocardial infarction.. Scientific reports. https://doi.org/10.1038/s41598-026-56805-x