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Although several studies have shown that endothelial dysfunction, inflammation and increased platelet activation may play roles in coronary slow flow phenomenon (CSFP),the etiopathogenesis of this condition is still unclear so we aimed to set predictors of CSFP based on clinical data and simple laboratory tests judged by angiography in patients with stable coronary artery disease.
Case control study included 120 patients with chronic stable angina who underwent coronary angiography (CA). They were classified into two groups: primary coronary slow flow (PCSF) group (60 patients ) and patients with normal coronary flow (control) group (60 patients). All patients were subjected to complete blood picture [ mean platelet count, total and differential leucocytic count and to detect [platelet-to lymphocyte ratio (PLR) & neutrophil-to-lymphocyte ratio (NLR) ]; serum uric acid; albumin & high sensitive CRP levels and CA to measure coronary blood flow using the TIMI frame count.
We found that the prevalence of diabetic mellitus and smoking were more common in the PCSF group (53.4% vs 26.7% ;p = 0.03 & 50.0% vs 20.0% p = 0.01) respectively compared to control group. Also we found PLR, NLR ,uric acid and Hs-CRP were high in PCSF group (244.01 ± 91.62 vs 111.93 ± 37.96) ,(4.70 ± 2.16 vs 1.44 ± 0.77),(7.37 ± 1.74 vs 5.01 ± 1.40) and ( 7.32 ± 2.08 vs 4.17 ± 1.81) compared to control group respectively (P < 0.0001).The diagnostic performance of PLR ≥ 150; NLR ≥ 2 ; albumin level ≤ 3.5 g/dl ; uric acid ≥ 6 mg/dl and Hs CRP ≥ 6 mg/L for prediction of CSFP were [sensitivity 83.3%, 90.0%, 50.0%, 76.7% and 83.3%] and [specificity 86.7%, 90.0%, 53.3%, 83.3%, 86.7%] respectively. The multivariate analysis showed that NLR ≥ 2 (OR = 8.867, 95% CI = 1.924 - 18.321,P = 0.009) was the only independent predictor of PSCF.
Coronary slow flow phenomena was common in smokers and diabetic patients and it is associated with high PLR, NLR, uric acid and Hs-CRP levels. The only independent predictor of CSFP was neutrophil to lymphocyte ratio (NLR).