The Relationship Between Neutrophil-to-lymphocyte Ratio And GRACE Score With Acute Myocardial Infarction

Objective: Acute myocardial infarction is a complex pathological process which neutrophiles and lymphocytes play an important role in it.Recently,Neutrophil-to-lymphocyte ratio,a new sign of biological inflammation marker,which combined with the specific immune and nonspecific immune system,was used to predict in-hospital mortality and lo ng-term mortality after acute myocardial infarction.GRACE score is now the most common clinical severity evaluation indicators for all patients with myocardial infarction.The purpose of this paper is to explore the clinical value of NLR with acute myocardial infarction patients through the relationship between neutrophil-to-lymphocyte ratio(N LR)and GRACE score.Methods: A total of 298 patients were included in this study,180 patients were diagnosed with ST segment elevation myocardial infarction STEMI),and 118 patients with non-ST segment elevation myocardial infarction(NSTEMI);124 patients experienced primary percutaneous coronary intervention(PCI).Calculate GRACE score of all patients.All patients were divided into low N LR group and high N LR group,124 patients who experienced primary PCI were divided into low NLR and high N LR group according to the best cut-off point(N LR = 3.574)through receiver operating characteristic curve(ROC curve).Routine blood items,troponin I(C TNI),brain natriuretic peptide(BNP)and renal function(UREA,CREA)were done right now when admitted to hospital,liver biochemistry,blood lipid,uric acid were done the next day morning.All these patients took dual antiplatelet drugs(asp irin combined chlorine),and echocardiography was done after 5-7 days.Pericardium effusion,ventricular septal rupture,ventricular aneurysm,mild heart failure,new arrhythmia,acute heart failure and death were recorded.SPSS 17.0 software was used for statistical analysis.Results:1.In STEMI group,WBC,N,NLR,HGB,CK – MB,CTNI were significantly higher than that in NSTEMI group(P < 0.05);In STEMI group,Bu N,CREA,UA were significantly lower than that in NSTEMI group(P < 0.05).2.The Spearman correlation analysis showed that the N LR and GRAC E score were positively correlated.ROC analysis showed that a NLR value of 3.574 had 67.4% sensitivity and 52.1% specificity for high GRAC E score.3.In all patients,there were 67.2% ST segment elevation myocardial infarction in high NLR group,this was significantly higher than that in low N LR group(P < 0.05).In high NLR group,WBC,N,BNP,CK – MB,CTNI,TB were significantly higher than that in low NLR group(P < 0.05);In high NLR group,L,HGB,TC were significantly lower than that in low NLR group(P < 0.05).4.The incidence of acute heart failure was significantly higher in high NLR group than that in low N LR group(P<0.05),both in all patients(10.92% vs 3.23%)and 124 patients experienced primary PCI(11.39% vs 0%).But there was no difference with new-onset arrhythmia(27.01% vs 17.74%),pericardium effusion(5.75% vs 4.83%),mild heart failure symptoms(6.90% vs 3.22%),ventricular aneurysm(1.15% vs 1.61%),ventricular septal rupture(0.57% vs 0%)between high and low N LR groups in all patients.Similarly,there was no difference with new-onset arrhythmia(26.58% vs 24.44%),pericardium effusion(5.06% vs 4.44%),mild heart failure symptoms(2.54% vs 0%),ventricular aneurysm(1.27% vs 0%),ventricular septal rupture(1.27% vs 0%)between high and low NLR groups in 124 patients experienced primary PCI.5.Multiariable Logistic regression analysis showed that NLR and BNP were risk factors for the onset of acute heart failure.6.ROC analysis showed that a NLR value of 3.574 had 85.7% sensitivity and 44.5% specificity for predicting acute heart failure.ROC analysis showed that a GRACE score value of 140.5 had 90.5% sensitivity and 52.8% specificity for predicting acute heart failure.ROC analysis showed that a NLR value of 3.574 combined with a GRAC E value of 140.5 had 90.7% sensitivity and 60.1% specificitfor predicting acute heart failure.Conclusions: NLR was positively associated with GRAC E score,the sensitivity and specificity of predicting high risk acute myocardial infarction was low.The value of predicting acute heart failure increased when NLR combined with GRAC E score,it prompts NLR can be used as a auxiliary index for risk stratification of GRAC E scores.