| BackgroundAcute coronary syndrome is a group of clinical syndrome which is characterized by vulnerable plague with eruption, bleeding and thrombosis, leading to acute occlusion of coronary lumen. According to the clinical features, ACS can be classified into unstable angina (UA), non-st-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI), in which UA and NSTEMI can be called non-ST-segment acute coronary syndrome (NSTACS). Data from the united states reveal that patients with NSTACS at least account for about 70% in all ACS, which is similar with condition in China. The therapeutic strategies varies on types of ACS. It is clear for patients with ACS, reperfusion therapy including thrombolysis and percutaneous coronary intervention(PCI) can significantly improve the early and late prognosis. Thus, the key of therapy strategy for STEMI patients is the timing of reperfusion.The prognosis for patients with NSTACS has a so broad range that their therapy mainly focuses on risk stratification. Conservative treatment is reasonable for patients with low to moderate risk, and early invasive therapy is suggestive for patients with high risk. It has been proved that several methods can be applied for risk stratification in patient with NSTACS, including The Thrombolysis In Myocardial Infarction score (TIMI) score, the Platelet glycoprotein Ⅱb/Ⅲa in Unstable angina:Receptor Suppression Using Integrilin Therapy trial(PURSUIT) score, and Global Registry Of Acute Coronary Events (GRACE) score. In which, GRACE score has been validated to predict the major adverse events during in-hospital and long-term follow up. Thus, risk stratification based on GRACE score has been recommended for the therapy strategies.Previous study demonstrated that there is a close relationship between inflammation and vulnerable plague. The inflammatory markers from C-creative protein, interleukin (IL-6), intercellular adhesion molecular(ICAM-1), matrix metalloproteinases(MMPs) and myeloperoxidase (MPO) are all proved to be related with the formation and development of unstable plague. However, they are not widely used in clinical practice for their poor sensitive and specific value on predicting prognosis. As main inflammatory cells, leucocyte is involved in all process of atherosclerosis. Data from previous studies showed total white cell count from peripheral blood and neutrophil as well as lymphoeytes could be a good predictor of coronary heart disease and its prognosis. The potential mechanism may be that both neutrophil and lymphoeytes could cause fiber cap thin and rupture. Moreover, neutrophil to lymphoeytes ratio (NLR) is the independent risk factor for restenosis, cardiac mortality, and long term prognosis, and its predictive performance is superior over white blood cells and neutrophil alone. Importantly, as a regular test in clinical practice, the easy availability of NLR provides a easy tool for risk evaluation in patients with NSTACS. Up to date, there is no report about NLR as a toll for risk stratification in NSTACS. That’s the reason why we proposed such a hypothesis that NLR could have a potential value for predicting in-hospital cardiac events.Objective1. To investigate the predictive value of NLR on in-hospital cardiac events in patients with NSTACS2. To investigate the predictive value of GRACE score on in-hospital cardiac events in patients with NSTACS3. To compare the predictive performance of NLR with that of GRACE score on in-hospital cardiac events.Study subjectsThe patients with chest pain presenting to southern medical university affiliated zhujiang hospital were enrolled between July,2013 and Jan 2015. The" including criteria includes unstable angina and USTEMI. The exclusive criteria include STEMI, stable angina, aortic dissection, myocarditis, pericarditis, myocardiosis, cardiac vavular disease, pulmonary embolism, acute fever and tumorMethodsThe history of disease including age, sexy, smoking, alcohol, illicit drug use, hypertension, diabetes, coronary heart disease, PCI and CABG was collected when the patients were admitted. The blood speciman was collected at admission, automatic counting and classification of blood cells were performed by Heath XS800i.NLR was calculated as absolute value of neutrophil to lymphocyte. All patients were divided into low, moderate, and high ratio groups. The next morning, the peripheral blood was collected for routine biochemical tests including serum fast glucose, serum lipids, liver and kidney function. According to the medical history, physical examination and laboratory examination results on admission, GRACE score (range 50-237) was recorded. According to the 2012 ACCF/AHA guideline for NSTACS management, all patients were divided into low risk, intermediate risk, and high-risk group respectively. Coronary angiography (CAG) was applied in all involved patients. The invasive timing varied according to the different clinical situation of patients. Conventional femoral or radial artery was selected with Judkins method. The analysis of coronary artery stenosis was carried out by using image processing software. The loss of lumen area more than 50% was defined as coronary artery disease. During hospitalization, the therapeutic medication and cardiac events were closely monitored and recorded. A major in-hospital event was defined as a composite of cardiac death, acute heart failure or (and) cardiac shock, malignant arrhythmia,AMI with ST-segment elevation, and recurrent ischemia with ST-segment depression despite maximal medical therapy requiring an urgent PCI. SPSS 13.0 software package was used for statistical analysis of data, measurement data was expressed as mean±standard deviation (SD), the classified variable was expressed as the number(%). Comparison between two groups was carried by Wilcoxon test or x2 test. The independent effects of GRACE and NLR on study clinical events were assessed by multivariate binary logistic regression models. Variables associated with the events of interest in univariate analyses (p<0.05) were included in multivariate prediction models. The receiver operating characteristic (ROC) respectively of NLR and GRACE score on cardiac events prediction were performed, and the sensitivity and specificity were also be evaluated. The use of Delong method was to compare the ROC curves of NLR with GRACE score. P< 0.05 represents difference with statistical significance.Results1. There are 88 cases occurring cardiac events during hospitalization, the incidence of cardiac events is positive related with GRACE score and NLR respectively.2. After adjustment of left ventricular ejection fraction, eGFR, GRACE score, and syntax score, the results showed GRACE score and NLR are still the independent predictors of cardiac events in patients with NSTACS during hospitalization.3. The area under ROC for NLR predicting cardiac events in-hospitalization is 0.701.4. The difference between NLR and GRACE score had no statistic significance, indicating the NLR is at least not inferior over GRACE on predicting cardiac events in patients with NSTACS.ConclusionAs a easy and regular tool, NLR could be used as a predictor for cardiac events in patients with NSTACS. |
PDF Full Text Request