New Predictors in Determining the Need for Invasive Treatment in NSTEMI During the COVID-19 Pandemic? A Retrospective Study

Introduction: The non-invasive approach has become the first choice for the acute non-ST elevation myocardial infarction-acute coronary syndrome (NSTEMI-ACS) during the Coronavirus Disease-2019 (COVID-19) pandemic. However, most of these patients require interventional treatment. In this study, the possible role of hematological inflammatory markers in differentiating medium-high risk NSTEMI-ACS patients according to the GRACE risk classification in need of interventional treatment was investigated. Patients and Methods: Patients who underwent coronary angiography with the diagnosis of NSTEMI-ACS in a tertiary cardiology clinic between January 2018 and December 2019 were included in the study, which was designed as a retrospective cohort study. NSTEMI-ACS patients (n= 276), except for patients with exclusion criteria (n= 32), were divided into two groups as those in need of invasive treatment (n= 217) and medical treatment (n= 59) according to the results of coronary angiography. The hematological inflammatory markers were compared between groups. Results: Neutrophil to lymphocyte ratio (NLR) (AUC: 0.637, 95% CI: 0.563-0.712, p= 0.001) and systemic immune-inflammation index (SII) (AUC: 0.622, 95% CI: 0.545-0.699, p= 0.004) predicted the requirement of interventional treatment in NSTEMI-ACS. Conclusion: It is unclear whether the NLR and SII elevation, which may be a predictor of the need for invasive treatment, is a cause or a consequence of the pathophysiological process in patients with NSTEMI-ACS. However, elevated NLR and SII values can help distinguish NSTEMI-ACS patients who need invasive treatment during the COVID-19 pandemic. The results of this study, show the need for large-sized studies to determine the ideal cut-off point of NLR and SII levels in determining the treatment strategy for NSTEMI-ACS.