Predicting value of neutrophil to lymphocyte ratio combined with GRACE score on in-hospital major adverse cardiovascular events of postoperative PCI in acute STEMI patients

doi:10.3969/j.issn.1004-583X.2022.05.004

Abstract

Abstract:

Objective To explore the predicting value of neutrophil to lymphocyte ratio (NLR) combined with global registry of acute coronary events (GRACE) score on in-hospital major adverse cardiovascular events (MACE) of postoperative primary percutaneous coronary intervention (PCI) of patients with acute ST-segment elevation myocardial infarction (STEMI). Methods From September 1, 2018 to December 31, 2019, a total of 275 patients with acute STEMI underwent primary PCI who visited the Department of Cardiology, Hebei General Hospital were enrolled and divided into the MACE group (n=35) and the non-MACE group (n=240), postoperative PCI in-hospital MACE included all-cause mortality, cardiogenic shock, in-hospital repeat revascularization, fatal arrhythmia, cardiac arrest. The clinical data was recored, the independent risk factors of in-hospital MACE were analyzed. The receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of NLR, GRACE score and the two combined for in-hospital MACE of postoperative PCI in acute STEMI patients. Results Compared with the non-MACE group, increased age, GRACE score, CRUSADE score and NLR and decreased estimated glomerular filtration rate were detected in the MACE group (all P<0.05). Multivariate Logistic regression analysis showed that GRACE score and NLR were independent risk factors of in-hospital MACE of postoperative PCI in patients with acute STEMI (all P<0.05). ROC curve indicated that GRACE score, NLR had certain predictive value for in-hospital MACE, while the two combined had a greater areas under curve for better predicting in-hospital MACE. Conclusion GRACE score and NLR are independent risk factors for in-hospital MACE of postoperative PCI in acute STEMI patients, the two combined has a greater predictive value for in-hospital MACE.

Key words: ST elevation myocardial infarction, percutaneous coronary intervention, major adverse cardiovascular events, GRACE score, neutrophil to lymphocyte ratio

CLC Number:

R542.22

Wang Jiaqi, Gao Man, Zhang Feifei, Li Yingxiao, Dang Yi, Qi Xiaoyong. Predicting value of neutrophil to lymphocyte ratio combined with GRACE score on in-hospital major adverse cardiovascular events of postoperative PCI in acute STEMI patients[J]. Clinical Focus, 2022, 37(5): 412-417.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.05.004

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I5/412

Figures/Tables 8

References 20

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组别	例数			年龄 (岁)			男性 [例(%)]		BMI (kg/m²)			GRACE评分 (分)				CRUSADE评分 (分)		TIMI危险评分 (分)		高血压 [例(%)]
MACE组	35			65.80±12.68			26(74.3)		25.60(24.49,27.40)			148(134,173)				26.50(19.00,40.75)		3.5(2,5.75)		19(54.3)
非MACE组	240			59.46±12.77			187(77.9)		25.34(23.10,27.10)			125(102.25,147.00)				20(13.25,30.00)		3(2,5)		127(52.9)
χ²/Z/t值				2.760			0.231		-1.460			-4.163				-2.891		-1.520		0.023
P值				0.008			0.631		0.144			<0.01				0.004		0.128		0.879
组别		例数			糖尿病 [例(%)]			高脂血症 [例(%)]			吸烟史 [例(%)]		饮酒史 [例(%)]		家族史 [例(%)]		心率 (次/min)		收缩压 (mmHg)
MACE组		35			7(20.0)			12(34.3)			15(42.9)		10(28.6)		5(14.3)		74.31±17.69		125.40±27.79
非MACE组		240			43(17.9)			72(30.0)			119(49.6)		70(29.2)		26(10.8)		77.19±17.26		132.20±25.38
χ²/Z/t值					0.089			0.264			0.553		0.005		0.101		-0.901		-1.463
P值					0.765			0.607			0.457		0.942		0.751		0.373		0.145
组别			例数			舒张压 (mmHg)				D2B时间 (min)		TIT (h)		Killip分级[例(%)]					院前心脏骤停 [例(%)]
组别			例数			舒张压 (mmHg)				D2B时间 (min)		TIT (h)		Ⅰ级			Ⅱ~Ⅳ级		院前心脏骤停 [例(%)]
MACE组			35			80.37±14.79				60(44, 72)		4(2.5, 6)		23(65.7)			12(34.3)		2(5.7)
非MACE组			240			81.91±14.91				60(46,77)		3.5(2, 5.5)		194(80.8)			46(19.2)		4(1.7)
χ²/Z/t值						-0.572				-0.594		-1.114		3.336					0.832
P值						0.568				0.553		0.265		0.068					0.362

组别	例数			年龄 (岁)			男性 [例(%)]		BMI (kg/m²)			GRACE评分 (分)				CRUSADE评分 (分)		TIMI危险评分 (分)		高血压 [例(%)]
MACE组	35			65.80±12.68			26(74.3)		25.60(24.49,27.40)			148(134,173)				26.50(19.00,40.75)		3.5(2,5.75)		19(54.3)
非MACE组	240			59.46±12.77			187(77.9)		25.34(23.10,27.10)			125(102.25,147.00)				20(13.25,30.00)		3(2,5)		127(52.9)
χ²/Z/t值				2.760			0.231		-1.460			-4.163				-2.891		-1.520		0.023
P值				0.008			0.631		0.144			<0.01				0.004		0.128		0.879
组别		例数			糖尿病 [例(%)]			高脂血症 [例(%)]			吸烟史 [例(%)]		饮酒史 [例(%)]		家族史 [例(%)]		心率 (次/min)		收缩压 (mmHg)
MACE组		35			7(20.0)			12(34.3)			15(42.9)		10(28.6)		5(14.3)		74.31±17.69		125.40±27.79
非MACE组		240			43(17.9)			72(30.0)			119(49.6)		70(29.2)		26(10.8)		77.19±17.26		132.20±25.38
χ²/Z/t值					0.089			0.264			0.553		0.005		0.101		-0.901		-1.463
P值					0.765			0.607			0.457		0.942		0.751		0.373		0.145
组别			例数			舒张压 (mmHg)				D2B时间 (min)		TIT (h)		Killip分级[例(%)]					院前心脏骤停 [例(%)]
组别			例数			舒张压 (mmHg)				D2B时间 (min)		TIT (h)		Ⅰ级			Ⅱ~Ⅳ级		院前心脏骤停 [例(%)]
MACE组			35			80.37±14.79				60(44, 72)		4(2.5, 6)		23(65.7)			12(34.3)		2(5.7)
非MACE组			240			81.91±14.91				60(46,77)		3.5(2, 5.5)		194(80.8)			46(19.2)		4(1.7)
χ²/Z/t值						-0.572				-0.594		-1.114		3.336					0.832
P值						0.568				0.553		0.265		0.068					0.362

组别	例数	桡动脉入路	预扩张	后扩张	术前TIMI血流		GPⅡb/Ⅲa 受体拮抗剂	血栓抽吸	支架数量(个)		冠状动脉内溶栓	前降支病变
组别	例数	桡动脉入路	预扩张	后扩张	0~1	2~3	GPⅡb/Ⅲa 受体拮抗剂	血栓抽吸	0~1	2~3	冠状动脉内溶栓	前降支病变
MACE组	35	30(85.7)	29(82.9)	20(57.1)	26(74.3)	9(25.7)	7(20.0)	12(34.3)	29(82.9)	6(17.1)	3(8.6)	20(57.1)
非MACE组	240	214(89.2)	205(85.4)	102(42.5)	179(74.6)	61(25.4)	55(22.9)	84(35.0)	194(80.8)	46(19.2)	24(10.0)	142(59.2)
χ²值		0.364	0.158	2.653	0.019		0.149	0.007	2.568		0.070	0.052
P值		0.546	0.691	0.103	0.999		0.700	0.934	0.463		0.791	0.820

组别	例数	桡动脉入路	预扩张	后扩张	术前TIMI血流		GPⅡb/Ⅲa 受体拮抗剂	血栓抽吸	支架数量(个)		冠状动脉内溶栓	前降支病变
组别	例数	桡动脉入路	预扩张	后扩张	0~1	2~3	GPⅡb/Ⅲa 受体拮抗剂	血栓抽吸	0~1	2~3	冠状动脉内溶栓	前降支病变
MACE组	35	30(85.7)	29(82.9)	20(57.1)	26(74.3)	9(25.7)	7(20.0)	12(34.3)	29(82.9)	6(17.1)	3(8.6)	20(57.1)
非MACE组	240	214(89.2)	205(85.4)	102(42.5)	179(74.6)	61(25.4)	55(22.9)	84(35.0)	194(80.8)	46(19.2)	24(10.0)	142(59.2)
χ²值		0.364	0.158	2.653	0.019		0.149	0.007	2.568		0.070	0.052
P值		0.546	0.691	0.103	0.999		0.700	0.934	0.463		0.791	0.820

组别	例数		白细胞计数 (×10⁹/L)		血红蛋白 (g/L)		NLR		eGFR[ml·min^-1· (1.73 m²)^-1]		空腹血糖 (mmol/L)		血小板计数 (×10⁹/L)		TC (mmol/L)		TG (mmol/L)
MACE组	35		11.21 (7.35,15.07)		135 (123,151)		7.217 (5.556,10.339)		89.57 (56.69,99.73)		5.94 (5.22, 7.31)		204 (168,258)		4.52 (4.02,5.03)		1.23 (0.93,1.92)
非MACE组	240		9.94 (7.87,12.75)		143 (129,155)		5.04 (3.575,7.362)		92.86 (81.77,102.77)		5.85 (4.99,7.37)		222 (188, 269)		4.5 (3.95,5.20)		1.32 (0.94,1.94)
Z值			-1.095		-1.861		-4.025		-2.337		-0.271		-1.161		-0.341		-0.404
P值			0.273		0.063		<0.01		0.019		0.787		0.245		0.733		0.686
组别		例数		HDL-C (mmol/L)		LDL-C (mmol/L)		脂蛋白a (mg/L)		CK-MB (U/L)		NT-proBNP (μg/L)		尿酸 (μmol/L)		LVEF (%)
MACE组		35		0.96 (0.86,1.19)		3.01 (2.56,3.31)		251.00 (101.10,502.90)		164 (83.7,290.6)		763 (464,1455)		359.6 (297.6,407.5)		54 (44, 59)
非MACE组		240		1.00 (0.87,1.12)		2.95 (2.52, 3.48)		212.64 (105.80,389.30)		120.50 (54, 235.07)		610.7 (354, 1152)		320.10 (267.5,394.5)		55 (48, 59)
Z值				-0.297		-0.444		-0.820		-1.686		-1.457		-1.772		-0.944
P值				0.767		0.657		0.412		0.092		0.145		0.076		0.345