Correlation Between NLR And Mace During Emergency PCI Hospitalization In Patients With Acute Myocardial Infarction

Objective: To investigate the correlation between the peripheral blood neutrophil to lymphocyte ratio(NLR)and MACE during emergency PCI hospitalization in patients with acute myocardial infarction.Subject and methods: 1.A total of 236 patients were enrolled,who with acute myocardial infarction hospitalized in the Department of cardiovascular medicine of First Hospital Affiliated to University of South China during 2015.3-2017.8.The patients were divided into two groups according to whether there were MACE(heart failure,malignant arrhythmia,stent thrombosis,revascularization,cardiogenic shock,cardiac arrest,cardiac death)during hospitalization: acute myocardial infarction with MACE group and acute myocardial infarction group without MACE group.The difference of between the two groups was compared.Two factors and multivariate Logistic regression analysis were conducted to explore the predictive value of NLR for the occurrence of hospitalization MACE after emergency PCI in patients with acute myocardial infarction.The ROC curve was applied to analyze the predictive value of NLR for the occurrence of hospitalization MACE too.Patients was divided into lower NLR group and higher NLR group according to the optimal cut-off on the ROC curve,and the differences of clinical data between the two groups were compared.Spearman correlation analysis was also used to compare the correlation between NLR and predictors of major adverse cardiovascular events in acute myocardial infarction.Result:1.There 72 MACE in 236 patients with acute myocardial infarction,concluding 45 cases of heart failure,26 cases of malignant arrhythmia,13 cases of cardiogenic shock,3 cases of sudden cardiac arrest,2 cases of stent thrombosis,1 cases of revascularization and 1 cases of death.The value of NLR,Cr,LVEF,hs-c Tn T(logarithm),NT-pro BNP(logarithm)and CRP levels were significantly higher in group 1(acute myocardial infarction with MACE group)comparing group 2(simple acute myocardial infarction group)(P < 0.05).In a multivariate logistic regression model,the elevated NLR(OR1.128,95%CI 1.008-1.263,P < 0.05),CRP(OR1.550,95%CI 1.340-1.792,P<0.05)and NT-pro BNP(OR 2.916,95%CI 1.368-6.217,P<0.05)were independent predictors of MACE in patients with acute myocardial infarction after emergency PCI.It suggesting that NLR value increases every 1,1.128 fold increase in the risk of MACE in patients with acute myocardial infarction during hospitalization,while CRP value increases 1,1.55 fold and NT-pro BNP value increases 10,2.916 fold.2.The ROC curve yielded an area under the curve value of 0.661(95% CI: 0.587-0.734,P<0.05),and demonstrated a sensitivity of 70.8% and a specificity of 51.2%(P<0.05)for the prediction of MACE in patients.The prediction efficiency is highest when NLR was the optimal cut-off of 7.364.NLR group of high value(NLR>7.364)myocardial infarction MACE rate was significantly higher than the low value group(NLR < 7.364)(P < 0.05).3.Spearman correlation analysis demonstrated that there was a positive correlation between NLR and AMI in patients with nosocomial MACE(R=0.256,P<0.05),also between NLR and CRP(R=0.307,P<0.05),NLR and NT-pro BNP(R=0.228,P<0.05),NLR and STEMI(R=0.199,P<0.05),NLR and LDL-C(R=0.293,P<0.05),but NLR was negatively correlated with LVEF(R=-0.144,P<0.05).Conclusion: Neutrophil to lymphocyte ratio(NLR)in peripheral blood is correlated with the occurrence of MACE in patients with acute myocardial infarction after emergency PCI during hospitalization,and high NLR value(NLR>7.364)may be an independent predictor of MACE in patients with acute myocardial infarction after emergency PCI during hospitalization.