Nomograms Based on the Albumin/Neutrophil-to-Lymphocyte Ratio Score for Predicting Coronary Artery Disease or Subclinical Coronary Artery Disease

Chen Wei, Wenjun Fan, Ying Zhang, Yixiang Liu, Zhenjiang Ding, Yueqiao Si, Jingyi Liu, Lixian Sun Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of ChinaCorrespondence: Lixian Sun, Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People’s Republic of China, Tel +86 0314 227 9016, Fax +86 0314 227 4895, Email lixiansun01@126.comPurpose: To develop and validate two nomograms incorporating the albumin/neutrophil-to-lymphocyte ratio score (ANS) for predicting the risk of coronary artery disease (CAD) or subclinical CAD.Patients and Methods: Four hundred fifty patients with suspected CAD who underwent coronary computed tomographic angiography were consecutively enrolled between September 2015 and June 2017. Nomograms were established based on independent predictors of CAD or subclinical CAD.Results: In total, 437 patients with suspected CAD who underwent coronary computed tomographic angiography were included. Male sex, age ≥ 65 years, smoking, hypertension, diabetes, dyslipidemia, ischemic stroke, and ANS were independent predictors of CAD and subclinical CAD. The areas under the curve of each nomogram were 0.799 (95% CI: 0.752– 0.846) and 0.809 (95% CI: 0.762– 0.856), respectively. The calibration curve and decision curve analysis showed good performance for the diagnostic nomograms. The prediction of CAD or subclinical CAD by the ANS was not modified by the independent predictors (all, p for interaction > 0.05).Conclusion: Our ANS-based nomograms can provide accurate and individualized risk predictions for patients with suspected CAD or subclinical CAD.Keywords: albumin/neutrophil-to-lymphocyte ratio score, ANS, coronary artery disease, diagnosis, nomogram