| Objective:To determine the effects of blood routine parameters on the long-term prognosis of elderly coronary heart disease(CHD)patients treated with percutaneous coronary intervention(PCI).Methods:According to the established inclusion and exclusion criteria,a total of 3024 elderly patients(aged≥60 years)hospitalized with CHD who underwent PCI in the First Affiliated Hospital of Xinjiang Medical University from January 2008 to December 2016 were included in this study.Demographic data and laboratory indicators were analyzed retrospectively.Long-term mortality events,including all-cause mortality(ACM)and cardiac mortality(CM),were set as primary endpoint events.Major adverse cardiovascular events(MACE)and major adverse cardiac and cerebrovascular events(MACCE)were set as secondary endpoint event.The patients were followed up for a long time by telephone follow-up,outpatient records and medical history review.The mean follow-up time was(35.9±22.6)months.The optimal tangential value of baseline blood routine parameters which included baseline circulating white blood cell(WBC)-related parameters,red blood cell(RBC)-related parameters,and platelet(PLT)-related parameters to predict ACM risk in elderly patients after PCI was obtained by using the subject work characteristic curve,and the patients were divided into a high-value group and a low-value group according to the tangential value.Kaplan-Meier survival curve was used to analyze the survival of the two groups,and Log-rank test was performed.After adjusting related confounding factors,multivariate Cox regression analysis was performed to further clarify the relationship between baseline blood routine parameters and adverse clinical outcomes in elderly CHD patients after PCI.Results:(1)WBC-related parameters:the optimum cut-off values of WBC count,monocyte(MO)count and neutrophil/lymphocyte ratio(NLR)were 8.05×10~9/L,0.5×10~9/L,and 2.9,respectively.(1)The incidence of ACM(10.4%vs.5.3%,P<0.001),CM(8.0%vs.4.1%,P<0.001),MACCE(17.7%vs.14.2%,P=0.021),and MACE(16.2%vs.12.5%,P=0.010)in the high-value WBC count group(WBC count≥8.05×10~9/L)was significantly higher;The cumulative survival rate of ACM,CM,MACCE,and MACE in the high-value WBC count group was significantly decreased(P<0.05).Multivariate Cox regression analysis showed that the risk of ACM occurrence in the group with high-value WBC count was increased by 60.0%compared with that in the group with low-value WBC count(HR=1.600,95%CI:1.146-2.234,P=0.006);(2)The incidence of ACM(8.7%vs.4.9%,P<0.001),CM(7.0%vs.3.6%,P<0.001),MACCE(17.5%vs.13.2%,P=0.001),and MACE(15.6%vs.11.7%,P=0.002)in the high-value MO count group(MO count≥0.5×10~9/L)was significantly higher;The cumulative survival rate of ACM and CM in the high-value MO count group was significantly decreased(P<0.05).Multivariate Cox regression analysis showed that the risk of CM occurrence in the high-value MO count group was increased by 50.7%compared with that in the group with low-value MO count(HR=1.507,95%CI:1.040-2.183,P=0.030).(3)The incidence of ACM(9.1%vs.5.5%,P<0.001),CM(6.7%vs.4.4%,P=0.009),MACCE(18.3%vs.13.7%,P=0.001),and MACE(16.4%vs.12.1%,P=0.001)in the high-value NLR group(NLR≥2.9)was significantly higher;The cumulative survival rate of ACM,CM,MACCE and MACE in the high-value NLR group was significantly decreased(P<0.05).Multivariate Cox regression analysis showed that there was no significant difference in the risk of adverse prognosis between the two groups(P>0.05).(2)RBC-related parameters:the optimum cut-off values of hemoglobin(HB)and red cell distribution width(RDW)were 131g/L and 13.5%,respectively.(1)The incidence of ACM(8.2%vs.5.6%,P=0.005)and CM(6.2%vs.4.4%,P=0.031)in the low-value HB group(HB<131g/L)was significantly increased;The cumulative survival rate of ACM and CM in the low-value HB group was significantly decreased(P<0.05).Multivariate Cox regression analysis showed that the risk of ACM occurrence in the high-value HB group was 31.3%lower than that in the low-value HB group(HR=0.687,95%CI:0.4899-0.966,P=0.031).(2)The incidence of ACM(9.1%vs.5.0%,P=0.005),CM(7.4%vs.3.7%,P<0.001),MACCE(17.2%vs.13.8%,P<0.001),and MACE(16.0%vs.11.9%,P=0.001)in the high-value RDW group(RDW≥13.5%)was significantly increased;The cumulative survival rate of ACM and CM in the high-value RDW group was significantly decreased(P<0.05).Multivariate Cox regression analysis showed that compared with the low-value group,the risk of ACM occurrence was increased by 59.2%(HR=1.592,95%CI:1.160-2.185,P=0.004),the risk of CM occurrence was increased by 75.9%(HR=1.759,95%CI:1.217-2.542,P=0.003)and the risk of MACE occurrence was increased by 35.1%(HR=1.351,95%CI:1.078-1.692,P=0.009)in the high-value RDW group.(3)PLT-related parameters:the optimum cut-off values of platelet count(PC),platelet distribution width(PDW)and mean platelet volume(MPV)were 199.5×109/L,16.6%and 9.3f L,respectively.(1)The incidence of ACM(7.3%vs.5.7%,P=0.004),the CM(5.8%vs.4.2%,P=0.042),MACCE(16.6%vs.13.4%,P=0.011)and MACE(15.2%vs.11.4%,P=0.003)in the high-value PC group(PC≥199.5×10~9/L)was significantly increased;The cumulative survival rate of ACM,CM,MACE and MACCE in the high-value PC group was significantly decreased(P<0.05).Multivariate Cox regression analysis showed that compared with the low-value group,the risk of ACM occurrence was increased by 46.6%(HR=1.466,95%CI:1.063-2.022,P=0.020),the risk of CM occurrence was increased by60.1%(HR=1.601,95%CI:1.100-2.330,P=0.014),the risk of MACCE occurrence was increased by 43.0%(HR=1.430,95%CI:1.153-1.773,P=0.001),and the risk of MACE occurrence was increased by 51.9%(HR=1.519,95%CI:1.207-1.911,P<0.001)in the high-value PC group.(2)The incidence of ACM(8.0%vs.5.6%,P=0.008)and CM(6.1%vs.4.4%,P=0.043)in the high-value PDW group(PDW≥16.6%)was significantly increased;There was no significant difference in the cumulative survival of ACM and CM between the two groups(P>0.05);Multivariate Cox regression analysis showed that there was no statistical difference in the risk of ACM and CM between the two groups(P>0.05).(3)The incidence of ACM(9.4%vs.5.9%,P=0.004),CM(8.2%vs.4.4%,P<0.001),MACCE(19.3%vs.14.2%,P=0.003)and MACE(17.2%vs.12.6%,P=0.005)in the high-value MPV group(MPV≥9.3f L)was significantly increased;The cumulative survival rate of MACCE and MACE in high-value MPV group was significantly decreased(P<0.05).Multivariate Cox regression analysis showed that compared with the low-value MPV group,the risk of MACCE occurrence was increased by 46.3%(HR=1.463,95%CI:1.131-1.892,P=0.004),and the risk of MACE occurrence was increased by 36.9%(HR=1.369,95%CI:1.047-1.791,P=0.022)in the high-value MPV group.Conclusion:As a simple and easily accessible clinical biomarker,WBC-related parameters(WBC count≥8.05×10~9/L and MO count≥0.5×10~9/L),RBC-related parameters(HB<131g/L and RDW≥13.5%)and PLT-related parameters(PC≥199.5×10~9/L and MPV≥9.3f L)can be an independent risk factor for poor prognosis in elderly patients with coronary heart disease after PCI.Monitoring parameters related to patients’admission baseline blood routine can realize long-term prognosis prediction in elderly patients with coronary heart disease after PCI,and is of great value for risk stratification and early management of patients. |
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