Predictive Value Of SII,WMR And The Combination Of Both For Major Adverse Cardiovascular Events After PCI In Patients With Acute STEMI

Objective:To investigate the predictive value of systemic immune inflammation index(SII),white blood cell count to mean platelet volume ratio(WMR)and the combination of both for the occurrence of major adverse cardiovascular events(MACE)in patients with ST-segment elevation myocardial infarction(STEMI)undergoing direct percutaneous coronary intervention(PCI).Methods:Retrospective analysis of 280 STEMI patients who visited the emergency department of the Affiliated Hospital of Chengde Medical College and underwent direct PCI from June 2020 to February 2022.The demographic characteristics,auxiliary examinations and follow-up data of the selected patients were recorded in detail.SII and WMR were calculated by blood routine,and global registry of acute coronary events(GRACE)score and Gensini score were calculated according to relevant scoring standards.According to the occurrence of MACE within 30 days after operation,the patients were divided into MACE group and non-MACE group.The differences of various indicators between the two groups were analyzed and compared.The independent risk factors of MACE in STEMI patients after PCI were analyzed by using binary logistic regression model.The predictive effect of various indicators on MACE in STEMI patients after PCI was analyzed by the receiver operating characteristic curve(ROC).According to the best diagnostic cut-off values of SII and WMR for predicting the occurrence of MACE obtained by ROC curve analysis,the patients were divided into low SII group and high SII group,low WMR group and high WMR group,and the incidence of MACE was compared between each group.The correlation between SII,WMR and Gensini score was analyzed by Spearman test.Results:1.Among 280 patients with STEMI,there were 84 patients(30.0%)in MACE group,including 8 patients(2.9%)with cardiac deaths,19 patients(6.8%)with heart failure,23 patients(8.2%)with recurrent angina,5 patients(1.8%)with recurrent myocardial infarction,22 patients(7.9%)with target vessel revascularization,and 7 patients(2.5%)with malignant arrhythmia;there were 196 patients(70.0%)in non-MACE group.2.Compared with non-MACE group,the proportion of patients in MACE group in Killip class≥Ⅱ,dyslipidemia,and three vessel diseases was higher,with statistically significant difference(P<0.05);White blood cell count,neutrophil count,platelet count,mean platelet volume,SII,WMR,GRACE score and Gensini score all increased by 19.5%,27.4%,18.6%,2.9%,66.9%,19.6%,12.6%and 58.5%respectively,with statistically significant difference(P<0.05).3.Binary logistic regression analysis showed that dyslipidemia,Killip class≥Ⅱ,three-vessel disease,SII,WMR,GRACE score,Gensini score were closely related to MACE in STEMI patients after PCI(P<0.05),and SII,WMR,GRACE score,Gensini score were independent risk factors for the occurrence of MACE in STEMI patients after PCI.4.ROC curve was used to analyze the diagnostic value of SII,WMR,GRACE scores,the combination of two or three indicators for MACE in STEMI patients after PCI.The results showed that the area under curve,the best diagnostic cut-off value,sensitivity and specificity of SII were 0.761,2018.455,71.4%and 73.5%respectively;The corresponding values of WMR were 0.725,1.025,84.5%and 51.0%respectively;The corresponding values of GRACE score were 0.682,144.000,56.0%and 70.9%respectively.The area under curve,sensitivity and specificity of SII combined with WMR were 0.811,81.0%and 68.4%respectively;The corresponding values of SII combined with GRACE score were 0.832,79.8%and 74.0%respectively;The corresponding values of WMR combined with GRACE score were0.805,65.5%and 81.1%respectively;The corresponding values of combination of three indicators were 0.865,88.1%and 72.4%respectively.Delong test showed that compared with single indicator,SII combined with WMR and the combination of three indicators had higher diagnostic value.5.According to the best diagnostic cut-off value of SII,the subjects were divided into low SII group(SII≤2018.455)and high SII group(SII>2018.455).The difference in the number of patients with MACE between the two groups was statistically significant(P<0.001).Compared with the low SII group,the risk of MACE in the high SII group increased by about 5.92 times(OR:6.923,95%CI:3.916-12.239,P<0.001),and the risk of heart failure,recurrent angina and recurrent myocardial infarction was higher(P<0.05).According to the best diagnostic cut-off value of WMR,the subjects were divided into low WMR group(WMR≤1.025)and high WMR group(WMR>1.025).The difference in the number of patients with MACE between the two groups was statistically significant(P<0.001).Compared with the low WMR group,the risk of MACE in the high WMR group increased by 4.69 times(OR:5.689,95%CI:2.957-10.944,P<0.001),and the risk of heart failure and recurrent angina was higher(P<0.05).6.Spearman correlation analysis showed that SII(r_s=0.333,P<0.001),WMR(r_s=0.215,P<0.001)were positively correlated with Gensini score.Conclusion:Preoperative SII and WMR of STEMI patients can be regarded as independent risk factors for short-term MACE after PCI,which has certain clinical value for early prediction of MACE,and the combined prediction value of both is higher,and can improve the prediction value of GRACE score,providing reference for early clinical identification of high-risk patients and prediction of short-term adverse prognosis of patients.