Association Between Peripheral Inflammatory Markers And The Severity Of Coronary Artery Disease In Patients With Myocardial Infarction

Background: Atherosclerosis is not only a process of simple lipid deposition，but an inflammatory disease. The culprit of acute myocardial infarction is nolonger the lumen of the narrow but plaque instability which cause myocardialischemia and infarction. Inflammatory reaction involves in plaquestarting,development and rupture.Objective: The aim of this study was to explor the association betweenperipheral inflammation makers and the severity of coronary artery Disease，and seek an efficient and inexpensive index, which can evaluate the conditionof coronary artery and predict the prognosis of disease through detectingPeripheral white blood cell count c-reactive protein level in patients withST-segment elevation myocardial infarction. And then discover the high-riskgroups in population census.Methods: In this study，181patients with STEMI in whom primarypercutaneous coronary intervention (PCI) was performed in The first hospitalof Jilin university between February2012and November2012wereincluded.Collect the baseline characteristics, main clinical and laboratoryvariables and results of coronary angiography results at admission.All patientsis divided into three groups according to the tertiles of the Gensini score. Allanalyses were conducted using SPSS19.0for Windows statistical software. Continuous variables were expressed as mean±standard deviation andcategorical variables were expressed as percentages. Distribution of parametricvalues was evaluated with1-sample Kolmogorov-Smirnov test. Comparison ofcategorical variables between the groups was performed using the chi-squaretest. Analysis of variance was used in the analysis of continuous variables. Astratified post hoc analysis of clinical and laboratory variables was performedaccording to the tertiles of the Gensini score. The correlation between theGensini score and clinical， laboratory parameters was assessed by theSpearman correlation test. Multiple linear regression analysis was performed toidentify the independent predictors of the Gensini score by including theparameters，which were correlated with the Gensini score in bivariate analysis.Standardized bregression coefficients and their significance from multiplelinear regression analysis were reported. A2-tailed P<.05was consideredsignificant.Result：1、Baseline information:There is no obvious difference among age，sex，hypertension and diabetes in the three group（P>0.05）.2、Peripheralinflammatory markers: The hypersensitive C-reactive protein, total number ofwhite blood cells， neutrophils and Neutrophil to Lymphocyte ratio of thehigh group were higher than the mild and the low grouop, and with the severitydegree of coronary artery lesions,their level gradually increased and werepositively correlated with Gensini score, while the lymphocyte level was to thecontrary.3、General laboratory examination：Myoglobin，peak troponin I，heart ejection fraction，high density lipoprotein level were obvious different amongthe three group，as the disease was severity，the myoglobin and the peaktroponin I increased, while HDL levels and ejection fraction decreased.4、Multiple linear regression analysis showed that neutrophilic/lymphocyte，hypersensitive C-reactive protein and Lymphocyte can independent predict theseverity of coronary artery disease in patients with ST-segment elevationmyocatdial infarction。Neutrophilic/lymphocyte had the most valuabale。5、The higher Gensini score has，the more incident of MACE is on addmison。Conclusion: There was a positive correlation between severity of coronaryatherosclerosis and white blood cells，neutrophil，neutrophilic/lymphocyte，hypersensitive C-reactive protein，but Lymphocyte was negative。Multiplelinear regression analysis indicate that neutrophilic/lymphocyte，hypersensitiveC-reactive protein and Lymphocyte could independent prediction of coronarylesions and neutrophilic/lymphocyte and neutrophilic/lymphocyte had thestrongest valuabale。With neutrophils/lymphocyte increased, and the higher theincidence of adverse cardiovascular events occured.