Platelet-to-White Blood Cell Ratio (PWR): A Novel Prognostic Biomarker for Spontaneous Reperfusion after Primary Percutaneous Coronary Intervention.

Background: Spontaneous reperfusion (SR) occurring before primary percutaneous coronary intervention (PPCI) can offer additional clinical benefits to patients with ST-segment elevation myocardial infarction (STEMI). The Platelet-to-White Blood Cell Ratio (PWR) has been recognized as a prognostic indicator in various diseases. We aimed to explore the relationship between PWR and SR in patients with STEMI undergoing PPCI. Methods: We conducted a retrospective analysis involving 995 patients diagnosed with STEMI who underwent PPCI in a single-center setting. Demographic, clinical, laboratory, and angiographic data were extracted from the hospital database, and PWR was calculated by dividing serum platelet levels by white blood cell levels. Results: Angiographic SR was observed in 203 patients (20.4%). The SR group displayed elevated PWR values (24.4 ± 8.9 vs. 21.6 ± 7.6, p < 0.001) and a lower incidence of the no-reflow phenomenon (NRF) (13.3% vs. 22.9%, p = 0.003), along with a reduced SYNTAX (SX) score (12.7 ± 6.4 vs. 17.8 ± 7.9, p < 0.001). Furthermore, the group with a high PWR was associated with a higher rate of SR, a lower NRF rate, decreased in-hospital mortality, and reduced SX scores. Multivariable logistic regression analyses revealed that female gender, hemoglobin levels, the presence of SR, Culprit lesion, and the SX score were identified as risk factors for high PWR. High PWR, SX score, and Initial CK-MB levels were the factors associated with SR. Conclusions: Patients with high PWR at presentation may experience higher rates of SR, fewer complications, and a more favorable prognosis in the context of STEMI.