Study On The Relationship And Prognosis Between NHR,PNI And SYNTAX Score In Patients With Acute Myocardial Infarction

Objective:To investigate the relationship between neutrophil/high-density lipoprotein ratio(NHR)and prognostic nutrition index(PNI)in patients with acute myocardial infarction and SYNTAX score and prognosis.Methods:Patients with acute myocardial infarction who visited the Department of Cardiology of the First Hospital of Lanzhou University between February 2019 and December 2019 and received coronary angiography + percutaneous coronary intervention within 12 hours after admission were selected.According to the results of the patient’s perfect coronary angiography after admission,SYNTAX score were evaluated,and patients with acute myocardial infarction were grouped according to the results of SYNTAX score.SYNTAX score 1-22 were grouped into the group of mild coronary lesions;SYNTAX score 23-32 were incorporated into the group of moderate coronary lesions;SYNTAX score greater than 33 points were classified into the group with high coronary lesions.The clinical history data,biochemical indexes,blood indexes and cardiac ultrasound indexes of the three groups were retrospectively analyzed.The correlation between NHR,PNI and SYNTAX score was analyzed.The ROC curves of NHR,PNI and predicting the complexity of coronary lesions were plotted.Kaplan-Meier survival analysis was used to compare survival between groups at 18 months of follow-up.The patients were regrouped according to the SYNTAX score,and 1-22 were divided into the group of patients with mild complex coronary artery lesions,and greater than 23 were divided into the group of patients with nonmild complex coronary artery lesions.At the same time,according to the cut-off point of NHR ROC curve,the patients were divided into high NHR group(NHR>7.32)and low NHR group(NHR<7.32).PNI was divided into PNI0(≥45)and PNI1(<45),and Kaplan-Meier survival analysis was used to compare the survival status of the two groups at 18 months of follow-up.Results:1.Overall: 204 patients with AMI were included according to the inclusion and exclusion criteria of this study,and were grouped according to SYNTAX score.Among them,148 cases were in the group of mild complicated coronary artery lesions;42 cases in the group of moderate complex coronary artery lesions;There were 14 cases in the group of severe complicated coronary artery lesions.There were 88 cases in the high NHR group and 116 cases in the low NHR group.There were 149 cases in the PNI 0group and 55 cases in the PNI 1 group.2.Compared with the different groups of complex coronary lesions in the light,medium and severe groups of AMI,the difference between NHR and PNI was statistically significant,and P was less than 0.05;the NHR was statistically significant in the comparison between the three groups,P was less than 0.05;the PNI of the group with severe complex coronary lesions was lower than that in the group with mild complex coronary lesions,and the PNI in the group with moderate complex coronary lesions was lower than that in the group with mild complex coronary lesions,and P was less than 0.05.The group with severe complicated coronary disease had the highest NHR and the lowest PNI,the lowest NHR and the highest PNI in the group with mild complex coronary disease,and the NHR in the moderately complicated coronary disease group.3.Spearman correlation analysis found that NHR was positively correlated with the SYNTAX score scale,with a correlation coefficient of 0.336 and a P-value <of0.001,while the PNI index was negatively correlated with the SYNTAX score scale,with a correlation coefficient of-0.328 and a P-value of <0.001.4.The area under the ROC curve of NHR,PNI and the combination of the two for the diagnosis of medium and severe coronary complex lesions in AMI was 0.704 [95%CI(0.629-0.778)]、0.701 [95% CI(0.621-0.772)]、0.741 [95% CI(0.668-0.814)],between 0.6 and 0.8,respectively,and the NHR,PNI and the two combined for AMI Severe complex coronary lesions have some predictive value.5.The prognosis of patients with AMI in different groups was compared with Kaplan-Meier survival analysis after 18 months follow-up: the survival probability of non-cause death in patients with non-mild complex coronary lesions(moderate and severe complex coronary artery lesions)decreased faster than that in the patients with mild complex coronary lesions,and the survival probability without all causes in the high NHR and PNI1 groups decreased rapidly,and the survival comparison between the groups was statistically significant(P <0.05)。The survival outcomes of patients with moderate and severe complex coronary lesions,high NHR,and PNI1 groups were less than those in the mild and complicated coronary lesions,low NHR,and PNI0 groups.Conclusion:1.The NHR level of AMI patients was positively correlated with the SYNTAX score to assess the complexity of coronary lesions,and the PNI level was negatively correlated with the SYNTAX score for assessing the complexity of coronary lesions2.NHR,PNI and NHR combined with PNI have certain predictive value in assessing the complexity of coronary lesions in AMI patients.3.In patients with AMI,the all-cause mortality was higher in the group with severe complicated coronary disease,high NHR,and PNI1 than mild complicated coronary disease,low NHR,and PNI0 group(follow-up 18 months).