الفهرس 
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Abstract
Cardiovascular diseases are the number one causes of mortality in humans worldwide, and coronary syndrome (myocardial infarction, MI) is one of the prevalent conditions those are responsible fatal heart attack and heart failure. Impaired vascular perfusion in myocardial infarction and reperfusion causes the damage of the myocardium, depending on the duration of ischaemia and metabolic demand of the tissue. Therefore, systematic and local inflammation can be triggered, which is important in the remodelling and the scar formation of the myocardium. There are two main phases of inflammation during Myocardial infarction: the inflammatory phase and the proliferative phase. Neutrophils are the first leukocytes to be found in damaged area. Their activation produces large amounts of inflammatory mediators those regulate the response to tissue injury, demonstrating hypoxic damage, proteolytic enzymes, and other mediators. Inflammation plays an important pathogenic role in the initiation and progression of atherosclerotic plaque lesions. C-reactive protein (CRP), which directly participates in plaque inflammation, induces vascular cell adhesion molecule-1 (VCAM-1) expression in endothelial cells. However, the levels and values of high-sensitivity (hs)-CRP, white blood cell (WBC) count, and VCAM-1 in chronic coronary syndrome. The electrocardiogram (ECG) finding is important in the diagnosis of myocardial ischemia. However, it is estimated that only 1/3 of patients with acute myocardial infarction have ECG classical elevation of the ST segment indicating myocardial ischemia. Since many patients with chest pain have not specific ischemic changes on the electrocardiogram, the diagnosis in these cases largely depends on the increase concentration of the serum markers of myocardial injury. The work aimed to investigate the existence of deference in NLR between patients with AMI and patients with chronic coronary syndrome. This study was carried out on sixty consecutive patients with acute MI and acute coronary syndrome. The patients were divided into two equal groups: • group I: patients with acute MI. • group II: patients with acute coronary syndrome. The summary of the result: • There was no significant difference between the studied groups regarding demographic data (age, gender, residence, previous medical history and smoking). • Blood pressure was significantly higher in group I compared to group II (P values<0.001). • By comparing between both groups, WBCs, neutrophil, NLR, monocytes, CRP, troponin I and CK-MB were significantly higher in group I compared to group II (P values<0.05) while eosinophil was significantly lower in group I compared to group II (P values <0.05). • Lymphocytes and basophils were insignificantly different between both groups. • ECG findings were insignificantly different between the studied groups. • The mean EF was insignificantly different between both groups. Number of patients with EF 45 - 50% was insignificantly different between both groups, Number of patients with EF 47 - 60% was significantly higher in group I compared to group II while Number of patients with EF 55 - 63% was significantly lower in group I compared to group II (P values= 0.006, 0.010 respectively). • Regarding group I, NLR had a significant positive correlation with neutrophil (r=0.856, P<0.001), CRP (r=0.382, P=0.037), Troponin I (r=0.417, P=0.022), CK-MB (r=0.378, P=0.039) and a significant negative correlation with lymphocyte (r=-0.684, P<0.001) and EF (r=-0.401, P=0.028) while no significant correlation was found between NLR and (age, BP, WBCs, monocyte, eosinophil and basophil. • Regarding group II, NLR had a significant positive correlation only with neutrophil (r=0.780, P<0.001), and had a significant negative correlation with lymphocyte (r=-0.745, P<0.001) and EF (r=-0.601, P<0.001) while no significant correlation was found between NLR and (age, BP, WBCs, monocyte, eosinophil, basophil, CRP, troponin I and CK-MB). • The relationship between NLR and age, sex, residence, HTN and smoking was insignificantly different. Diabetic patients and those with dyslipidemia had significantly higher NLR compared patients with no DM or dyslipidemia (P value=0.026). • Patients with abnormal NLR had significantly higher CRP, troponin I, CK-MB and more abnormal ECG findings compared to those with normal NLR (P values<0.05). EF was significantly lower in patients with abnormal NLR compared to those with normal NLR (P value<0.001). • NLR can significantly predict acute MI with AUC of 0.844 (P value<0.001), at cut off >2.69, it‘s a significant predictor for MI with 90% sensitivity, 63.33% specificity. Troponin I can significantly predict acute MI with AUC of 0.828 (P value<0.001), at cut off >6.64, it‘s a significant predictor for MI with 76.67% sensitivity, 63.33 specificity. CK-MB can significantly predict acute MI with AUC of 1.00 (P value<0.001), at cut off >30.06, it‘s a significant predictor for MI with 100% sensitivity, 100% specificity. • By comparing between NLR, troponin I and CK-MB, CK-MB was the best diagnostic of acute MI with AUC of 1.00, the diagnostic accuracy of NLR and troponin I for acute MI was comparable.