The Predictive Value Of Monocyte/High-density Lipoprotein For No Reflow After PCI In Elderly Patients With STEMI

Purpose:In this study,we aimed to investigate the relationship between Monocyte/High-density Lipoprotein(MHR)and no-reflow phenomenon in elderly patients with STEMI undergoing primary percutaneous coronary intervention.Methods:One hundred and thirty-four consecutive elderly patients admitted to the Shandong provincial hospital from September 2016 to October 2018,who had their first attack and received primary PCI within 12 hours were retrospectively enrolled.According to the occurrence of no-reflow during primary PCI,all the cases were divided into no-reflow group(TIMI flow grade 0-2,n=54)and normal flow group(TIMI flow grade 3.n=80)(The normal flow group were randomly selected and eligible for inclusion in the study).The age,gender,previous history of hypertension,diabetes,smoking and drinking,white blood cell count,neutrophil count,lymphocyte count,monocyte count,platelet count,platelet distribution width,hemoglobin Alc,C-reactive proteintotal cholesterol,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesteroI(LDL-C),etc.were recorded in the patients and the control group.Calculate MHR=Monocyte Number/High Density Lipoprotein Cholesterol.MHR levels were compared between the two groups of patients with normal flow group and no-reflow group,and the correlation between the phenomenon of no-reflow after direct PCI of STEMI patients and the above factors was analyzed.The ROC curve was used to demonstrate the optimal cut-off value,sensitivity and specificity of MHR on no-reflow phenomenon.Logistic regression analysis was used to evaluate predictive value of MHR for no-reflow phenomenon after PCI.Results:Basic clinical characteristics of the two groups:no-reflow group and normal flow in the gender history,history of hypertension,hyperlipidemia,diabetes,smoking,alcohol consumption,blood lipid level(total cholesterol,high-density lipoprotein cholesterol,low density lipoprotein cholesterol)aspects of basic clinical data to compare differences had no statistical significance(P>0.05).The c-reactive protein was significantly higher than that in the normal flow group(22.69±28.67 vs 13.33±17.18),the WBC count was higher than that in the normal flow group(11.12±3.93 vs 9.5±3.3),the neutrophil count was higher than that in the normal flow group(8.32±3.63 vs 7.18±3.14),the monocyte count was higher than that in the normal flow group(0.83±0.23 vs 0.63±0.32),and the MHR value was significantly higher than that in the normal flow group(0.85±0.43 vs 0.56±0.3).The difference was statistically significant(p<0.05).The area under the ROC curve for ratio was 0.70(95%CI 0.604-0.800,p<0.01).At a cut-off point of 33%,the value of MHR exhibited 63%in sensitivity and 70%in specificity for detecting no-reflow phenomenon during primary PCI.CONCLUSION:MHR is an independent factor for predicting no-reflow after PCI in elderly STEMI patients,and has certain predictive value for the occurrence of no-reflow in patients.