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Background  Inflammation is involved in the pathogenesis and progression of coronary artery diseases (CADs), including acute coronary syndrome. The neutrophil-to-lymphocyte ratio (NLR) has been identified as a novel marker of the pro-inflammatory state. We aimed to evaluate the predictive efficacy of the NLR for the prognosis of patients with new-onset ACS.    Methods  We retrospectively included consecutive patients with new-onset ACS treated with emergency coronary angiography. NLR was measured at baseline and analyzed by tertiles. The severity of coronary lesions was evaluated by the Gensini score. Correlations of NLR with the severity of CAD and the incidence of major adverse cardiovascular diseases (MACEs) during follow-up were determined.    Results  Overall, 737 patients were included. The NLR was positively correlated with the severity of coronary lesions as assessed by Gensini score ( P  < 0.05). During the follow-up period (mean, 43.49 ± 23.97 months), 65 MACEs occurred. No significant association was detected between baseline NLR and the risk of MACEs during follow-up by either Kaplan–Meier or Cox regression analysis. Multivariable logistic regression analysis showed that a higher NLR was independently associated with coronary lesion severity as measured by the Gensini score (1st tertile vs. 3rd tertile hazard ratio [HR]: 0.527,  P  < 0.001, and 2nd tertile vs. 3rd tertile HR: 0.474,  P  = 0.025).    Conclusions  The NLR may be associated with coronary disease severity at baseline but is not associated with adverse outcomes in patients with new-onset ACS.    Ethics Approval Number  2019XE0208

Predictive efficacy of neutrophil-to-lymphocyte ratio for long-term prognosis in new onset acute coronary syndrome: a retrospective cohort study