{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T06:59:06Z","timestamp":1780901946962,"version":"3.54.1"},"reference-count":26,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T00:00:00Z","timestamp":1780704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Hematological parameters derived from complete blood count (CBC) are inexpensive and widely available markers with potential utility in risk stratification of acute coronary syndrome (ACS). However, their incremental prognostic value when used alongside contemporary risk stratification tools such as the Troponin-only Manchester Acute Coronary Syndrome (T-MACS) score remains unclear. Methods: In this prospective, single-center cohort study, 521 patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina were enrolled. Admission CBC parameters (white blood cell count, neutrophils, monocytes, red cell distribution width, mean platelet volume) and derived inflammatory indices (neutrophil-to-lymphocyte ratio, white blood cell-to-mean platelet volume ratio, lymphocyte-to-monocyte ratio, mean platelet volume-to-platelet ratio, and red cell distribution width-to-platelet ratio) were recorded. T-MACS risk scores were calculated, and patients were followed for 30-day major adverse cardiac events (MACE), mortality, and coronary interventions. Associations were assessed using univariate and multivariate logistic regression analyses. Results: Patients experiencing 30-day MACE or mortality had significantly higher white blood cell counts, neutrophil counts, and WMR values (all p &lt; 0.05). Several hematological indices showed significant associations with T-MACS risk categories. In multivariate analysis, intermediate- and high-risk T-MACS classifications independently predicted 30-day MACE (OR 4.49, 95% CI:1.46\u201313.77, p = 0.009; OR 9.34, 95% CI:3.00\u201329.03, p &lt; 0.001, respectively), whereas white blood cell count, neutrophil count, and WMR did not demonstrate independent prognostic value beyond T-MACS classification. Conclusions: Admission white blood cell count, neutrophil count, and WMR are associated with short-term adverse outcomes and T-MACS risk severity in patients with NSTE-ACS. However, these markers do not provide additional prognostic value beyond T-MACS classification. These findings suggest that CBC-derived inflammatory markers primarily reflect disease severity rather than incremental prognostic information in the contemporary high-sensitivity troponin era.<\/jats:p>","DOI":"10.3390\/jcm15124399","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:43:46Z","timestamp":1780897426000},"page":"4399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Hematological Inflammatory Markers with T-MACS-Based Risk Stratification in Patients with Non-ST-Elevation Acute Coronary Syndrome"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1109-2169","authenticated-orcid":false,"given":"Ebru","family":"\u00c7etin Kenan","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Bursa Y\u00fcksek \u0130htisas Training and Research Hospital, Bursa 16310, T\u00fcrkiye"},{"name":"Department of Emergency Medicine, Bursa City Hospital, Bursa 16110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1572-2500","authenticated-orcid":false,"given":"Enad","family":"Kenan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Bursa Y\u00fcksek \u0130htisas Training and Research Hospital, Bursa 16310, T\u00fcrkiye"},{"name":"Department of Emergency Medicine, Bursa Orhangazi State Hospital, Bursa 16800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehtap","family":"Bulut","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Bursa Y\u00fcksek \u0130htisas Training and Research Hospital, Bursa 16310, T\u00fcrkiye"},{"name":"Department of Emergency Medicine, Bursa City Hospital, Bursa 16110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"437","DOI":"10.5603\/CJ.a2015.0015","article-title":"White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome","volume":"22","author":"Dehghani","year":"2015","journal-title":"Cardiol. J."},{"key":"ref_2","first-page":"3J","article-title":"What have we learned about the biology of atherosclerosis? The role of inflammation","volume":"88","author":"Libby","year":"2001","journal-title":"Am. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"225","DOI":"10.5603\/CJ.a2016.0001","article-title":"White blood cell count to mean platelet volume ratio: A novel and promising prognostic marker for ST-segment elevation myocardial infarction","volume":"23","author":"Cicek","year":"2016","journal-title":"Cardiol. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.amjcard.2012.09.014","article-title":"Mean platelet volume and long-term mortality in patients undergoing percutaneous coronary intervention","volume":"111","author":"Shah","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"666","DOI":"10.5603\/KP.a2017.0068","article-title":"The prognostic value of the platelet-to-lymphocyte ratio in acute coronary syndrome: A systematic review and meta-analysis","volume":"75","author":"Li","year":"2017","journal-title":"Kardiol. Pol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1136\/emermed-2016-205983","article-title":"Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: Single biomarker re-derivation and external validation in three cohorts","volume":"34","author":"Body","year":"2017","journal-title":"Emerg. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e273","DOI":"10.1017\/S0950268820002769","article-title":"Development and validation of a simple risk score for diagnosing COVID-19 in the emergency room","volume":"148","author":"Sung","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"359","DOI":"10.5603\/CJ.2016.0038","article-title":"White blood cell count to mean platelet volume ratio as a novel blood cell parameter. Authors\u2019 reply","volume":"23","author":"Cicek","year":"2016","journal-title":"Cardiol. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1111\/j.1538-7836.2009.03584.x","article-title":"Mean platelet volume as a predictor of cardiovascular risk: A systematic review and meta-analysis","volume":"8","author":"Chu","year":"2010","journal-title":"J. Thromb. Haemost."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"300060520959510","DOI":"10.1177\/0300060520959510","article-title":"Correlation of neutrophil-to-lymphocyte ratio with the prognosis of non-ST-segment elevation in patients with acute coronary syndrome undergoing selective percutaneous coronary intervention","volume":"48","author":"Wang","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_12","first-page":"116","article-title":"Predictive Value of Hematological Parameters in Non-ST Segment Elevation Myocardial Infarction and Their Relationship with the TIMI Risk Score","volume":"7","author":"Bulut","year":"2021","journal-title":"J. Cardiovasc. Emerg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Babes, E.E., Zaha, D.C., Tit, D.M., Nechifor, A.C., Bungau, S., Andronie-Cioara, F.L., Behl, T., Stoicescu, M., Munteanu, M.A., and Rus, M. (2021). Value of Hematological and Coagulation Parameters as Prognostic Factors in Acute Coronary Syndromes. Diagnostics, 11.","DOI":"10.3390\/diagnostics11050850"},{"key":"ref_14","first-page":"e51423","article-title":"White Blood Cell\/Mean Platelet Volume Ratio as a Predictor of Long-Term Outcomes but Not Coronary Artery Disease Severity in Non-ST Elevation Myocardial Infarction Patients","volume":"15","author":"Demir","year":"2023","journal-title":"Cureus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/S0002-9149(96)00878-8","article-title":"Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease","volume":"79","author":"Ommen","year":"1997","journal-title":"Am. J. Cardiol."},{"key":"ref_16","first-page":"1005","article-title":"Analysis of Platelet Morphological Parameters as Clinical Risk Stratification in Acute Coronary Syndrome","volume":"105","author":"Zhang","year":"2025","journal-title":"Catheter Cardiovasc Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"275","DOI":"10.2147\/JBM.S457371","article-title":"Haematological Indices in Acute Coronary Syndrome Patients in Ethiopia: A Comparative Cross-Sectional Study","volume":"15","author":"Tadesse","year":"2024","journal-title":"J. Blood Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"596","DOI":"10.26599\/1671-5411.2023.08.008","article-title":"Prognostic value of hematological parameters in older adult patients with acute coronary syndrome undergoing coronary intervention: A single centre prospective study","volume":"20","author":"Khan","year":"2023","journal-title":"J. Geriatr. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"82","DOI":"10.5830\/CVJA-2023-011","article-title":"Systemic immune-inflammation index, and neutrophilto-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronary syndrome","volume":"35","author":"Karadeniz","year":"2024","journal-title":"Cardiovasc J. Afr."},{"key":"ref_20","first-page":"4136126","article-title":"Is Neutrophil-to-Lymphocyte Ratio a Predictor of Coronary Artery Disease in Western Indians?","volume":"2017","author":"Sharma","year":"2017","journal-title":"Int. J. Inflam."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"706852","DOI":"10.3389\/fcvm.2021.706852","article-title":"The Neutrophil-to-Lymphocyte Ratio Is an Important Indicator Predicting In-Hospital Death in AMI Patients","volume":"8","author":"Ji","year":"2021","journal-title":"Front Cardiovasc Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e062384","DOI":"10.1136\/bmjopen-2022-062384","article-title":"Relationship between the red cell distribution width-to-platelet ratio and in-hospital mortality among critically ill patients with acute myocardial infarction: A retrospective analysis of the MIMIC-IV database","volume":"12","author":"Tong","year":"2022","journal-title":"BMJ Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.repc.2015.03.014","article-title":"The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention","volume":"34","author":"Pusuroglu","year":"2015","journal-title":"Rev. Port. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1186\/s12872-020-01614-x","article-title":"The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: A systematic review and meta-analysis","volume":"20","author":"Quan","year":"2020","journal-title":"BMC Cardiovasc Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"557","DOI":"10.3109\/09537104.2011.584086","article-title":"Mean platelet volume\/platelet count ratio as a predictor of long-term mortality after non-ST-elevation myocardial infarction","volume":"22","author":"Azab","year":"2011","journal-title":"Platelets"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"102","DOI":"10.23736\/S0026-4725.18.04836-3","article-title":"The prognostic value of mean platelet volume to platelet count ratio in older patients with non-ST elevation acute coronary syndrome receiving primary percutaneous coronary intervention: A retrospective study","volume":"67","author":"Sun","year":"2019","journal-title":"Minerva Cardioangiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4399\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T06:20:11Z","timestamp":1780899611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,6]]},"references-count":26,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124399"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124399","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,6]]}}}