Relationship Between PDW And The Degree Of Coronary Artery Disease In NSTEMI And Its Impact On Prognosis

Objective: To observe the correlation between platelet distribution width(PDW)and the degree of coronary artery disease in acute non-ST segment elevated myocardial infarction(NSTEMI)and its impact on prognosis.Methods: A total of 407 inpatients diagnosed with NSTEMI by coronary angiography at the Department of Cardiology,The Second Hospital of Dalian Medical University from April 2019 to October 2021 due to chest tightness and chest pain were included in this study,and the gender and age of the enrolled patients were collected,their height and weight were recorded and the body mass index(BMI)was derived according to the formula.The patients were also examined for history of hypertension,diabetes mellitus,smoking and past drug use.Blood was collected immediately after admission for routine blood tests,myocardial markers,BNP and fasting blood tests for liver biochemistry,renal function,glycosylated hemoglobin,ultrasensitive C-reactive protein,lipids and other biochemical parameters in the morning of the second day.The GRACE score and the Gensini score were improved according to the patient’s heart rate and blood pressure at the time of admission and according to the imaging results.PDW in blood was divided into 4 groups by quadratic method,q1,q2,q3 and q4.The number of cases in q1 group was 116,90 in q2 group;110 in q3 group and 101 in q4 group.All patients enrolled were followed up in an outpatient or inpatient setting and by telephone text message,and their occurrence of death from any cause,adverse cardiovascular event(MACE)within1 year was recorded.The primary endpoint was defined as cardiovascular death,nonfatal stroke,and nonfatal infarction.Secondary endpoints were defined as all-cause death,hospitalization for heart failure,and coronary revascularization.Statistical tests were performed according to the variability of the subjects in the 4 group using Spearman correlation analysis of platelet distribution width with Gensini score and GRACE score,Kaplan-Meier survival curves were applied for survival analysis,Cox regression was used to screen for risk factors associated with the occurrence of MACE events,and subject operator characteristic curve was used(ROC)to assess the predictive value of the above risk factors in MACE events.Results: 1.The proportion of patients with diabetes was statistically different among the 4 groups(P<0.05),and the proportion of patients with diabetes was higher in the high PDW group.there was no statistical difference in age,sex,BMI,history of hypertension,history of smoking and history of drug use among the 4 groups(P>0.05).2.There were statistical differences in platelets,mean platelet volume,uric acid,albumin,creatinine,and homocysteine between the 4 groups(P<0.05).q4 group had lower platelets than q1 and q2 groups(P<0.05),higher mean platelet volume than q1,q2 and q3 groups(P<0.05),higher uric acid than q1 group(P<0.05),and higher albumin than q1 group(P<0.05).Albumin was higher than q2 and q3 groups(P<0.05).creatinine and homocysteine were higher in q3 group than q1 group(P<0.05).albumin was lower in q2 group than q1 group(P<0.05).platelet pressure,urea,glycosylated hemoglobin,LDL,HDL,triglycerides,cholesterol,left ventricular ejection fraction,ultrasensitive C-reactive protein,and There were no statistical differences in alanine aminotransferase,aspartate aminotransferase,troponin,CK-MB isoenzyme and B-type natriuretic peptide(P>0.05).3.Spearman’s correlation analysis showed a positive correlation between PDW and Gensini score(r=0.478,p<0.001).PDW also showed a positive correlation with GRACE score(r=0.538,p<0.001).4.In Kaplan-Meier survival analysis,it was shown that the wind incidence of MACE events was increased in the high PDW group(p<0.05).5.one-way Cox regression analysis was used to pretest predictors of MACE events in NSTEMI patients.The results showed that diabetes mellitus(P = 0.018),platelet distribution width(P = 0.002),mean platelet volume(P = 0.005),and alanine aminotransferase(P = 0.128)were risk factors for the occurrence of outcome events in patients with NSTEMI.Substituting these indicators into a multifactorial COX regression,platelet distribution width was obtained as one of the independent predictors of the occurrence of the outcome event(HR: 1.478;95% CI: 0.947-2.305;P = 0.035).6.ROC curves were drawn using the relevant risk factors obtained above,including history of diabetes,platelet distribution width,mean platelet volume and alanine aminotransferase,in which the calculated AUC for platelet distribution width was 0.784,P < 0.05,which was statistically significant,indicating that platelet distribution width has some value in predicting the occurrence of MACE events,and the combined platelet distribution width with mean platelet volume,history of diabetes mellitus and alanine aminotransferase calculated AUC of 0.787,P<0.05,indicating that combining multiple related risk factors still has some value in predicting the occurrence of MACE events.Conclusion: 1.Platelet distribution width was positively correlated with coronary Gensini score in patients with NSTEMI,and there is a correlation with risk factors related to NSTEMI,which can provide clinical value for assessing the degree of coronary artery lesions in patients with NSTEMI,early intervention and early treatment.2.Platelet distribution width combined with mean platelet volume,history of diabetes mellitus and alanine aminotransferase have some predictive value for the occurrence of MACE events in patients with NSTEMI.