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Funding Acknowledgements Type of funding sources: None. Background  Inflammation is the basic mechanism of acute coronary syndrome (ACS). Among the various inflammatory markers related to ACS is the neutrophil-lymphocyte ratio (NLR). Neutrophils act as a mediator of inflammatory response to acute damage of myocardium, while lymphocytes decrease because of apoptosis caused by inflammation. Therefore, high NLR suggests further risk of infarction of the myocardium. Purpose This study determines the cut-off value and the role of NLR at admission in predicting in-hospital mortality of ACS patients.  Methods  A retrospective cohort study was conducted using data of patients admitted with ACS from the SCIENCE registry between February 2019 and November 2020. The inclusion criterion was complete blood count measurement at presentation. NLR was calculated from the absolute neutrophil and lymphocyte count. The optimal cut-off value of NLR was determined using receiver operating characteristic (ROC) curve and Youden index (J) analysis. Patients was divided into two groups based on the NLR cut-off value. In-hospital mortality between the two groups was compared using Chi-square test with a risk estimate to obtain the relative risk. Results  A total of 1147 ACS patients aged 60,70 ± 10,951 years old were included in the study. Area under the ROC curve was 0,607 (95% CI: 0,559-0,655; p &amp;lt;0,001). The optimal cutoff value of NLR to predict mortality was 10,7566 (sensitivity: 39,8%, specificity: 79,5%, J: 0,193). In-hospital mortality occurred in 64 of 266 (24,1%) patients with NLR &amp;gt;10,7566 and in 97 of 881 (11%) patients with NLR &amp;lt;10,7566, with relative risk 2,185 (95% CI: 1,645-2,904; p &amp;lt;0,001). Conclusion  In ACS patients with NLR &amp;gt;10,7566, there is an increased mortality risk 2,185 times higher compared to ACS patients with NLR &amp;lt;10,7566. Therefore, NLR can be used to predict in-hospital mortality in ACS patients. Mortality incidence between NLR groupsNLR &amp;gt;10.7566 (n= 266)NLR &amp;lt;10.7566 (n= 881)P-valueRelative risk95% CIMortality64 (24.1%)97 (11%)&amp;lt;0.0012.1851.645-2.904Non-mortality202 (75.9%)784 (89%)NLR neutrophil-lymphocyte ratio, CI: confidence interval, P-value considered significant if &amp;lt;0.005Abstract Figure. ROC curve of NLR

Role of neutrophil-lymphocyte ratio in predicting mortality in acute coronary syndrome patients