Predictive Value Of GRACE Score Combined With Neutrophilic Lymphocyte Ratio On No Reflow Phenomenon After Percutaneous Coronary Intervention In Patients With Acute ST-segment Elevation Myocardial Infarction

Objective: To explore the relationship between GRACE score combined with the neutrophilic lymphocyte ratio(NLR)and no-reflow phenomenon after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods: A retrospective analysis was performed on 269 patients with acute STEMI who received percutaneous coronary intervention at the cardiac center of Hebei General Hospital from October 1,2018 to December 31,2019.According to the results of angiography,they were divided into two groups: there flow group(n=225)and no-reflow group(n=44).Binary Logistic regression analysis was used to identify the independent predictors of no-reflow,and ROC curves were performed to evaluate the predictive value of GRACE score,NLR and the combined factor.Results: A total of 269 patients were included,and the incidence of no reflow was 16.3%.After adjusting for confounding factors,the results of binary logistic regression analysis showed that GRACE score [OR: 1.011,95% CI: 1.002～1.020,P = 0.017],NLR [OR: 1.068,95% CI: 1.008～1.132,P = 0.025] were independent predictors of no reflow.In the predictive value of no reflow,The area under ROC curve(AUC)of GRACE score was 6.21(95% CI: 0.553～0.709),sensitivity was 79.5%,specificity was 44.2%,the best critical value was 118.5;The AUC of NLR was 6.14(95% CI: 0.512～ 0.715),sensitivity was 91%,specificity was38%,the critical value was 10.97.The AUC of GRACE score combined with NLR was 6.41(95% CI 0.550 ～ 0.732,P = 0.03).The predictive ability of combined predictors was compared with GRACE score and NLR separately.The results showed that there was no significant difference in the predictive ability between combined predictors and GRACE alone[(95%CI-0.0363～-0.0755)Z=0.687,P=0.49](P > 0.05),combined predictors and NLR alone [(95%CI-0.0486～-0.103)Z=0.705 P=0.48](P > 0.05).And there was no significant difference between NLR and GRACE score [(95% CI-0.111～-0.126)Z = 0.127,P = 0.89](P >0.05).Conclusion: GRACE score and NLR are independent predictors of no reflow,GRACE score combined with NLR is a better indicator to predict the no reflow in STEMI patients after percutaneous coronary intervention,but is not superior to GRACE score or NLR alone.