Predictive Value of Neutrophil-Lymphocyte Ratio for Long-Term Cardiovascular Event Following Coronary Artery Bypass Grafting

Gurbuz, Orcun; Kumtepe, Gencehan; Ozkan, Hakan; Karal, Ilker Hasan; Velioglu, Yusuf; Ercan, Abdulkadir; Yüksel, Ahmet; Ener, Serdar

doi:10.21470/1678-9741-2018-0362

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Brazilian Journal of Cardiovascular Surgery

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ORIGINAL ARTICLE • Braz. J. Cardiovasc. Surg. 35 (3) • May-Jun 2020 • https://doi.org/10.21470/1678-9741-2018-0362 copy

Predictive Value of Neutrophil-Lymphocyte Ratio for Long-Term Cardiovascular Event Following Coronary Artery Bypass Grafting

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) for long-term major adverse cardiac and cerebrovascular events (MACCE), which have not yet been well described, in patients undergoing coronary artery bypass grafting (CABG).

Methods:

The records of 751 consecutive patients who underwent elective CABG between January 2008 and January 2010 were retrospectively enrolled and stratified according to quartiles of preoperative NLR. At 7.8-year follow-up, MACCE was considered as an endpoint.

Results:

Overall MACCE was 11.6% of all cases. Long-term myocardial infarction, percutaneous coronary intervention, stroke and cardiovascular mortality were found associated with the upper NLR quartile (P<0.001, P<0.001, P=0.005, P<0.001, respectively). In multivariate analysis, NLR on admission remained an independent predictor of long-term MACCE (OR 1.087, 95% CI 1.026-1.151; P=0.004), in all EuroSCORE risk groups (P<0.001; P<0.001; P=0.029). The receiver operating characteristic (ROC) curve analyses revealed an NLR cut-off value of 4.32 predicting MACCE.

Conclusion:

NLR is a useful and readily available predictive marker of long-term MACCE following CABG, independent of the EuroSCORE.

Keywords:
Coronary Artery Bypass; Percutaneous Coronary Intervention; Myocardial Infarction; Lymphocytes; Stroke; Neutrophils

Abbreviations, acronyms & symbols
ACT	= Activated clotting time	ICU	= Intensive care unit
CABG	= Coronary artery bypass grafting	LMCA	= Left main coronary artery
CAD	= Coronary artery disease	MACCE	= Major adverse cardiac and cerebrovascular events
COPD	= Chronic obstructive pulmonary disease	NLR	= Neutrophil-lymphocyte ratio
CPB	= Cardiopulmonary bypass	ON-BH CABG	= On-pump beating-heart CABG
CrCl	= Creatinine clearance	PCI	= Percutaneous cardiac intervention
CTnI	= Cardiac troponin I	PVD	= Peripheral vascular disease
EuroSCORE	=European System for Cardiac Operative Risk Evaluation	ROC	= Receiver operating characteristic
IABP	= Intra-aortic balloon pumping	STEMI	= ST elevation myocardial infarction

Characteristics	Univariate analysis			Multivariate analysis
Characteristics	OR	95% CI	P-value	OR	95% CI	P-value
Demographics
Age (years)	1.050	1.024-10.76	<0.001^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Male sex	1.215	0.702-2.103	0.48
Laboratory parameters
WBC	0.997	0.918-1.083	0.99
Neutrophil	1.120	1.026-1.222	0.011^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Lymphocyte	0.461	0.333-0.638	<0.001^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
NLR	1.109	1.063-1.156	<0.001^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count	1.087	1.026-1.151	0.004^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
CRP	1.045	0.974-1.122	0.21
Hg	0.922	0.833-1.020	0.92
CrCL	0.991	0.983-0.998	0.014^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Risk factors and medical history
Obesity	1.348	0.836-2.175	0.22
EuroSCORE	1.182	1.094-1.277	<0.001^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
USAP	0.923	0.571-1.492	0.74
History of MI (>21 days)	1.723	1.101-2.698	0.017^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
History of PCI	1.187	0.630-2.235	0.59
Current smoker	0.795	0.501-1.261	0.32
Family history of CAD	0.489	0.270-0.887	0.019^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count	0.409	0.180-0.928	0.032^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
IDDM	2.280	1.205-4.313	0.011^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Dyslipidaemia	1.092	0.667-1.785	0.72
Hypertension	2.150	1.344-3.427	0.001^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count	2.575	1.416-4.683	0.002^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
COPD	1.686	0.812-3.504	0.16
Asymptomatic carotid stenosis	2.073	1.258-3.416	0.004^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
PVD	2.187	1.109-4.311	0.024^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
History of stroke	1.997	0.807-4.942	0.13
Estimated LVEF 30-49%	1.006	0.606-1.671	0.98
Estimated LVEF <30%	1.831	0.881-3.806	0.1
Mild valvular insufficiency	1.378	0.827-2.298	0.21
Angiographic findings
LMCA stenosis	1.863	1.134-3.063	0.014^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Average number of vessel disease	1.491	0.978-2.272	0.06
Three-vessel disease	1.736	1.028-2.931	0.039^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Perioperative data
Number of distal anastomosis	1.190	0.932-1.518	0.16
Incomplete revascularization	0.824	0.333-2.037	0.67
Endarterectomy	1.233	0.734-2.072	0.42
CPB time	1.012	0.988-1.036	0.33
Perioperative IABP	7.660	2.415-24.298	0.001^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Perioperative inotropic agent	2.962	1.705-5.147	<0.001^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Perioperative AF	1.670	0.916-3.045	0.09
Perioperative MI	1.098	0.505-2.387	0.81
Prolonged respiratory period	1.520	1.137-2.032	0.005^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count	5.438	1.723-17.163	0.004^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Duration of ICU stay	1.008	0.999-1.017	0.08
Pulmonary complication	1.230	0.775-1.925	0.38
Perioperative renal failure	2.072	0.188-3.611	0.01^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count	3.028	1.089-2.048	0.026^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Cerebrovascular complication	2.490	1.318-4.704	0.005^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Blood transfusion	1.281	1.137-1.442	<0.001^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Length of hospital stay	1.353	1.206-1.518	<0.001^* * Statistically significant difference. AF=atrial fibrillation; CAD=coronary artery disease; CI=confidence interval; COPD=chronic obstructive pulmonary disease; CPB=cardiopulmonary bypass; CrCL=creatinine clearance; CRP=C-reactive protein; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IABP=intra-aortic balloon pump; ICU=intensive care unit; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count

	EuroSCORE ≤2			EuroSCORE 3-5			EuroSCORE ≥6
	OR	95% CI	P-value	OR	95% CI	P-value	OR	95% CI	P-value
Laboratory parameters
NLR	1.113	1.048-1.183	<0.001^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	1.161	1.060-1.273	0.001^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	1.127	1.012-1.255	0.029^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count
WBC	0.936	0.779-1.125	0.48	1.105	0.889-1.159	0.82	1.023	0.919-1.139	0.67
Lymphocyte	0.231	0.116-0.461	<0.001^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	0.606	0.355-1.035	0.06	0.575	0.347-0.953	0.032^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count
Neutrophil	1.143	0.916-1.426	0.23	1.175	1.000-1.380	0.05	1.070	0.955-1.198	0.24
CrCL	0.993	0.979-1.007	0.99	0.989	0.975-1.003	0.11	0.993	0.982-1.005	0.27
Risk factors and medical history
Age	1.025	0.965-1.090	0.41	1.019	0.974-1.067	0.41	1.059	1.009-1.112	0.02^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count
History of MI	2.016	0.740-5.494	0.17	1.426	0.666-3.057	0.36	1.213	0.616-2.387	0.57
Family history of CAD	0.635	0.234-1.722	0.37	0.594	0.240-1.469	0.26	0.236	0.57-0.984	0.047^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count
Hypertension	5.241	1.773-15.490	0.003^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	1.899	0.877-4.115	0.1	1.532	0.772-3.042	0.22
IDDM	2.208	0.653-7.466	0.2	4.918	1.979-12.219	0.001^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	0.996	0.305-3.254	0.99
Asymptomatic carotid stenosis	0.048	0-90770.430	0.68	2.408	1.088-5.325	0.03^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	1.294	0.658-2.546	0.45
PVD	10.595	2.443-45.944	0.002^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	1.496	0.421-5.317	0.53	1.158	0.409-3.283	0.78
Angiographic findings
LMCA stenosis	2.427	0.948-6.211	0.065	2.211	0.974-5.021	0.05	1.200	0.545-2.641	0.65
Three-vessel disease	1.862	0.687-5.049	0.22	1.168	0.515-2.653	0.71	1.898	0.829-4.349	0.13
Perioperative data
Perioperative IABP	-	-	-	4.871	0.661-35.918	0.12	6.150	1.463-25.854	0.013^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count
Perioperative inotropic agent	6.521	0.873-48.738	0.06	1.955	0.590-6.478	0.27	2.174	1.111-4.254	0.023^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count
Prolonged respiratory period	-	-	-	5.369	1.260-22.883	0.023^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	2.010	0.477-8.467	0.34
Perioperative renal failure	0.046	0-244.968	0.48	3.861	1.800-8.282	0.001^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	2.679	1.361-5.270	0.004^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count
Cerebrovascular complication	1.358	0.183-10.102	0.76	4.541	1.703-12.109	0.002^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	1.211	0.470-3.122	0.69
Blood transfusion	1.104	0.730-1.670	0.63	1.357	1.147-1.606	<0.001^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count	1.094	0.899-1.331	0.37
Length of hospital stay	1.125	0.697-1.816	0.63	1.075	0.914-1.264	0.38	1.111	1.007-1.224	0.035^* * Statistically significant difference. CAD=coronary artery disease; CI=confidence interval; CrCL=creatinine clearance; EuroSCORE=European System for Cardiac Operative Risk Evaluation; IABP=intra-aortic balloon pump; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; MACCE=major cardiac and cerebrovascular event; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; OR=odds ratio; PVD=peripheral vascular disease; WBC=white blood cell count

Characteristics	Overall	Quartile 1	Quartile 2	Quartile 3	Quartile 4	P-value
	n=751	n=189	n=188	n=187	n=187
		0.17-1.83	1.84-2.47	2.48-3.23	≥ 3.24
Laboratory parameters
NLR	3.04±2.69	1.3 ± 0.34	2.05 ± 0.19	2.87 ± 0.2	5.94 ± 4.07	<0.001^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. BMI=body mass index; CAD=coronary artery disease; COPD=chronic obstructive pulmonary disease; CrCL=creatinine clearance; CRP=C-reactive protein; CCS=Canadian Cardiovascular Society grading of angina; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
WBC (×10⁹/L)	7.74±2.65	7.37±2.8	7.74±2.26	7.53±2.8	8.34±2.62	<0.001^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. BMI=body mass index; CAD=coronary artery disease; COPD=chronic obstructive pulmonary disease; CrCL=creatinine clearance; CRP=C-reactive protein; CCS=Canadian Cardiovascular Society grading of angina; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
CRP	1.81±3.12	1.11±2.16	1.5±2.71	2.41±3.29	2.64±4.19	0.018^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. BMI=body mass index; CAD=coronary artery disease; COPD=chronic obstructive pulmonary disease; CrCL=creatinine clearance; CRP=C-reactive protein; CCS=Canadian Cardiovascular Society grading of angina; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Hg	11.05±2.31	10.90±2.34	11.07±2.31	11.11±2.35	11.10±2.26	0.69
CrCL	101.98±35.63	93.62±35.27	101.48±33.72	106.19±35.76	106.84±36.47	0.002^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. BMI=body mass index; CAD=coronary artery disease; COPD=chronic obstructive pulmonary disease; CrCL=creatinine clearance; CRP=C-reactive protein; CCS=Canadian Cardiovascular Society grading of angina; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Demographics
Age (years)	62.34±9.43	61.41±9.52	61.52±9.72	61.88±9.42	64.57±8.76	0.003^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. BMI=body mass index; CAD=coronary artery disease; COPD=chronic obstructive pulmonary disease; CrCL=creatinine clearance; CRP=C-reactive protein; CCS=Canadian Cardiovascular Society grading of angina; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Male	577 (76.8)	150 (79.4)	136 (72.3)	187 (80.7)	140 (74.9)	0.18
Risk factors and medical history
EuroSCORE	3.61±2.52	3.64±2.48	3.46±2.49	3.50±2.49	3.83±2.55	0.41
CCS	2.52±1.24	2.52±1.26	2.56±1.26	2.50±1.28	2.50±1.15	0.92
USAP	238 (31.7)	62 (32.8)	62 (33)	63 (33.7)	51 (27.3)	0.51
Obesity (BMI ≥30)	225 (33.3)	48 (25.4)	63 (33.5)	58 (31)	56 (29.9)	0.53
Current smoker	298 (39.7)	90 (47.6)	68 (36.2)	88 (47.1)	52 (27.8)	<0.001^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. BMI=body mass index; CAD=coronary artery disease; COPD=chronic obstructive pulmonary disease; CrCL=creatinine clearance; CRP=C-reactive protein; CCS=Canadian Cardiovascular Society grading of angina; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Hypertension	371 (49.4)	87 (46)	90 (47.9)	96 (51.3)	98 (52.4)	0.57
Dyslipidaemia	196 (26.1)	51 (27)	49 (26.1)	46 (24.6)	50 (26.7)	0.95
Family history of CAD	206 (27.4)	53 (28)	55 (29.3)	59 (31.6)	39 (20.9)	0.11
IDDM	54 (7.2)	10 (5.3)	9 (4.8)	12 (6.4)	23 (12.3)	0.018^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. BMI=body mass index; CAD=coronary artery disease; COPD=chronic obstructive pulmonary disease; CrCL=creatinine clearance; CRP=C-reactive protein; CCS=Canadian Cardiovascular Society grading of angina; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
COPD	50 (6.7)	10 (5.3)	12 (6.4)	9 (4.8)	19 (10.2)	0.15
History of stroke	28 (3.7)	8 (4.2)	7 (3.7)	5 (2.7)	8 (4.3)	0.32
PVD	34 (4.5)	12 (6.3)	3 (1.6)	6 (3.2)	13 (7)	0.027^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. BMI=body mass index; CAD=coronary artery disease; COPD=chronic obstructive pulmonary disease; CrCL=creatinine clearance; CRP=C-reactive protein; CCS=Canadian Cardiovascular Society grading of angina; EuroSCORE=European System for Cardiac Operative Risk Evaluation; Hg=haemoglobin level; IDDM=insulin-dependent diabetes mellitus; LMCA=left main coronary artery; LVEF=left ventricular ejection fraction; MI=myocardial infarction; NLR=neutrophil-lymphocyte ratio; PCI=percutaneous coronary intervention; PVD=peripheral vascular disease; USAP=unstable angina pectoris; WBC=white blood cell count
Asymptomatic carotid stenosis	115 (15.3)	35 (18.5)	26 (13.8)	24 (12.8)	30 (16)	0.42
History of MI	224 (29.8)	59 (31.2)	51 (27.1)	61 (32.6)	53 (28.3)	0.63
Estimated LVEF 30-49%	191 (25.4)	46 (24.3)	51 (27.1)	53 (28.3)	41 (21.9)	0.97
Estimated LVEF <30%	48 (6.4)	13 (6.9)	9 (4.8)	9 (4.8)	17 (9.1)	0.27
Mild mitral insufficiency	79 (10.5)	19 (10.1)	17 (9)	20 (10.6)	23 (12.3)	0.62
Previous PCI	73 (9.7)	23 (12.2)	15 (8)	18 (9.6)	20 (10.7)	0.56
Angiographic findings
Number of vessel disease	2.61±0.6	2.6±0.59	2.53±0.68	2.64±0.55	2.67±0.58	0.18
LMCA stenosis	125 (16.6)	28 (14.8)	31 (16.5)	30 (16)	36 (19.3)	0.7
Three-vessel disease	510 (67.9)	125 (66.1)	120 (63.8)	128 (68.4)	137 (73.3)	0.24

Characteristics	Overall	Quartile 1	Quartile 2	Quartile 3	Quartile 4	P-value
	n=751	n=189	n=188	n=187	n=187
		0.17-1.83	1.84-2.47	2.48-3.23	≥ 3.24
Operative data
Number of distal anastomoses	3.41±0.88	3.40±0.86	3.29±0.86	3.48±0.88	3.47±0.92	0.24
Incomplete revascularization	136 (18.1)	31 (16.4)	38 (20.2)	34 (18.2)	33 (17.6)	0.81
Number of grafted LAD	1.65±0.55	1.66±0.5	1.63±0.58	1.65±0.56	1.67±0.56	0.48
Number of grafted Cx	0.99±0.65	0.97±0.57	0.96±0.67	1±0.69	1.03±0.65	0.64
Number of grafted RCA	0.75±0.53	0.75±0.54	0.68±0.5	0.8±0.56	0.76±0.51	0.23
Endarterectomy	69 (9.2)	20 (10.6)	15 (8)	18 (9.6)	16 (8.6)	0.82
CPB time	87.83±26.5	87.45±26.68	85.92±30.57	85.1±21.55	94.52±26.47	0.76
Postoperative data
Hospital stay (days)	5.84±2.71	5.70±1.59	5.83±2.79	5.62±1.94	6.22±3.91	0.21
Prolonged mechanical ventilation time	19 (2.5)	2 (1.1)	3 (1.6)	4 (2.1)	10 (5.3)	0.038^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. AF=atrial fibrillation; CPB=cardiopulmonary bypass; Cx=circumflex coronary artery; cTnI=cardiac troponin I; FFP=fresh frozen plasma; IABP=intra-aortic balloon pump; LAD=left anterior descending coronary artery; LIMA=left internal mammary artery; MACCE=major adverse cardiac and cerebrovascular event; MI=myocardial infarction; NIMV=non-invasive mechanical ventilation; NSTEMI=non-ST elevation myocardial infarction; RCA=right coronary artery; STEMI= ST elevation myocardial infarction; TIA=transient ischemic attack
Intensive care unit stay (h)	22.8±45.81	19.15±6.45	22.02±25.25	20.55±16.79	29.54±86.21	0.007^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. AF=atrial fibrillation; CPB=cardiopulmonary bypass; Cx=circumflex coronary artery; cTnI=cardiac troponin I; FFP=fresh frozen plasma; IABP=intra-aortic balloon pump; LAD=left anterior descending coronary artery; LIMA=left internal mammary artery; MACCE=major adverse cardiac and cerebrovascular event; MI=myocardial infarction; NIMV=non-invasive mechanical ventilation; NSTEMI=non-ST elevation myocardial infarction; RCA=right coronary artery; STEMI= ST elevation myocardial infarction; TIA=transient ischemic attack
Drainage (ml/24 h)	511.63±298.83	508.65±304.34	500±252.55	496.9±308.31	544.71±330.99	0.7
Blood transfusion (unit)	1.35±1.54	1.24±1.39	1.23±1.58	1.25±1.42	1.69±1.71	0.002^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. AF=atrial fibrillation; CPB=cardiopulmonary bypass; Cx=circumflex coronary artery; cTnI=cardiac troponin I; FFP=fresh frozen plasma; IABP=intra-aortic balloon pump; LAD=left anterior descending coronary artery; LIMA=left internal mammary artery; MACCE=major adverse cardiac and cerebrovascular event; MI=myocardial infarction; NIMV=non-invasive mechanical ventilation; NSTEMI=non-ST elevation myocardial infarction; RCA=right coronary artery; STEMI= ST elevation myocardial infarction; TIA=transient ischemic attack
cTnI (ng/ml)	2.48±2.99	2.02±2.13	2.33±2.92	2.6±3.52	2.89±3.16	0.09
Perioperative inotropic support	42 (5.6)	7 (3.7)	9 (4.8)	8 (4.3)	18 (9.6)	0.048^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. AF=atrial fibrillation; CPB=cardiopulmonary bypass; Cx=circumflex coronary artery; cTnI=cardiac troponin I; FFP=fresh frozen plasma; IABP=intra-aortic balloon pump; LAD=left anterior descending coronary artery; LIMA=left internal mammary artery; MACCE=major adverse cardiac and cerebrovascular event; MI=myocardial infarction; NIMV=non-invasive mechanical ventilation; NSTEMI=non-ST elevation myocardial infarction; RCA=right coronary artery; STEMI= ST elevation myocardial infarction; TIA=transient ischemic attack
Perioperative IABP	7 (0.9)	1 (0.5)	2 (1.1)	1 (0.5)	3 (1.6)	0.65
Perioperative NSTEMI	62 (8.3)	20 (10.6)	14 (7.4)	15 (8)	16 (8.6)	0.72
Early STEMI (<30 days)	6	1 (0.5)	0	1 (0.5)	4 (2.1)	0.1
Perioperative AF	94 (12.5)	16 (8.5)	27 (14.4)	24 (12.8)	27 (14.4)	0.25
Perioperative renal failure	103 (13.7)	25 (13.2)	20 (10.6)	29 (15.5)	29 (15.5)	0.46
Pulmonary complication	21 (2.8)	4 (2.1)	6 (3.1)	3 (1.6)	8 (4.3)	0.4
Reintubation/NIMV	11 (1.4)	1 (0.5)	3 (1.6)	0	7 (3.7)	0.013^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. AF=atrial fibrillation; CPB=cardiopulmonary bypass; Cx=circumflex coronary artery; cTnI=cardiac troponin I; FFP=fresh frozen plasma; IABP=intra-aortic balloon pump; LAD=left anterior descending coronary artery; LIMA=left internal mammary artery; MACCE=major adverse cardiac and cerebrovascular event; MI=myocardial infarction; NIMV=non-invasive mechanical ventilation; NSTEMI=non-ST elevation myocardial infarction; RCA=right coronary artery; STEMI= ST elevation myocardial infarction; TIA=transient ischemic attack
Neurological complication	52 (6.9)	14 (7.4)	9 (8.4)	13 (7)	16 (8.4)	0.53
Encephalopathy	22 (2.9)	4 (2.1)	6 (3.2)	4 (2.1)	8 (4.3)	0.55
TIA	28 (3.7)	11 (5.8)	3 (1.6)	8 (4.3)	6 (3.2)	0.17
Stroke	5 (0.7)	0	0	1 (0.5)	4 (2.1)	0.034^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. AF=atrial fibrillation; CPB=cardiopulmonary bypass; Cx=circumflex coronary artery; cTnI=cardiac troponin I; FFP=fresh frozen plasma; IABP=intra-aortic balloon pump; LAD=left anterior descending coronary artery; LIMA=left internal mammary artery; MACCE=major adverse cardiac and cerebrovascular event; MI=myocardial infarction; NIMV=non-invasive mechanical ventilation; NSTEMI=non-ST elevation myocardial infarction; RCA=right coronary artery; STEMI= ST elevation myocardial infarction; TIA=transient ischemic attack
Mediastinitis	5 (0.7)	1 (0.5)	0	2 (1.1)	2 (1.1)	0.16
Early reoperation	12 (2.3)	4 (2.1)	3 (1.6)	2 (1.1)	3 (1.6)	0.49
Early reoperation due to bleeding	10 (1.3)	3 (1.6)	3 (1.6)	2 (1.1)	2 (1.1)	0.94
Early rehospitalisation (<30 days)	48 (6.4)	15 (7.9)	6 (3.2)	14 (7.5)	13 (7)	0.06
Mortality (<30 days)	8 (1.1)	1 (0.5)	1 (0.5)	0	6 (3.2)	0.011^* * Statistically significant difference. Values are presented as mean ± standard deviation or number (%), where appropriate. AF=atrial fibrillation; CPB=cardiopulmonary bypass; Cx=circumflex coronary artery; cTnI=cardiac troponin I; FFP=fresh frozen plasma; IABP=intra-aortic balloon pump; LAD=left anterior descending coronary artery; LIMA=left internal mammary artery; MACCE=major adverse cardiac and cerebrovascular event; MI=myocardial infarction; NIMV=non-invasive mechanical ventilation; NSTEMI=non-ST elevation myocardial infarction; RCA=right coronary artery; STEMI= ST elevation myocardial infarction; TIA=transient ischemic attack
MACCE (<30 days)	19 (2.5)	4 (2.1)	2 (1.1)	4 (2.1)	9 (4.8)	0.12

Characteristics	Overall	Quartile 1	Quartile 2	Quartile 3	Quartile 4	P-value
	n=751	n=189	n=188	n=187	n=187
		0.17-1.83	1.84-2.47	2.48-3.23	≥3.24
Mean follow-up time (months)	78.2±15.79	80.83±12.13	80.3±12.13	79.37±14.36	72.25±20.65	<0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
MACCE-free survival	76.03±18.35	80.03±13.41	79.83±13.81	76.66±18.33	67.32±23.33	<0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
MACCE (1 year)	23 (3.1)	1 (0.5)	2 (1.1)	7 (3.7)	13 (7)	0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
MACCE (3 years)	42 (5.5)	3 (1.6)	7 (4.3)	8 (4.3)	24 (12.8)	<0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
MACCE (7.8 years)	87 (11.6)	11 (5.8)	7 (3.7)	20 (10.8)	49 (26.5)	<0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
STEMI	31 (4.1)	3 (1.6)	3 (1.6)	7 (3.7)	19 (10.2)	<0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
Stroke	23 (3.1)	3 (1.6)	3 (1.6)	4 (2.1)	13 (7)	0.005^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
Late reintervention	34 (4.6)	3 (1.6)	0	11 (5.8)	20 (10.7)	<0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
PCI	30 (4)	3 (1.6)	0	10 (5.3)	17 (9.1)	<0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
Redo-CABG	2 (0.3)	0	0	0	2 (1.1)	0.1
Pacemaker	2 (0.3)	0	0	1 (0.5)	1 (0.5)	0.56
All-cause mortality	60 (8)	8 (4.2)	9 (4.8)	15 (8)	28 (15)	<0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
Cardiovascular mortality	40 (5.3)	3 (1.6)	5 (2.7)	8 (4.3)	25 (13.4)	<0.001^* * Statistically significant difference. Values are represented as mean ± standard deviation and number (%), where appropriate. CABG=coronary artery bypass grafting; MACCE=major adverse cardiac and cerebrovascular event; PCI=percutaneous coronary intervention; STEMI=ST elevation myocardial infarction
Non-cardiovascular mortality	19 (2.6)	5 (2.6)	4 (2.1)	7 (3.7)	3 (1.6)	0.62

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OG	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published
GK	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
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IHK	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
YV	Drafting the work or revising it critically for important intellectual content; final approval of the version to be published
AE	Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content
AY	Drafting the work or revising it critically for important intellectual content
SE	Drafting the work or revising it critically for important intellectual content

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[1] Correspondence Address: Orcun Gurbuzhttps://orcid.org/0000-0001-8553-7939 epartment of Cardiovascular Surgery, Meddem Hospital Modern Evler Mah. Suleyman Demirel Cad. No:179, Isparta, Turkey Zip code: 32200 E-mail: gurbuzorcun@gmail.com