Correlation Between NLR Combined With GRACE Score And Cardiac Function And Prognosis In Patients With Acute Coronary Syndrome

ObjectiveIt is well known that acute coronary syndrome(ACS)is characterized by acute onset and high mortality.Early detection of high-risk patients with acute coronary syndrome and intervention therapy is of great significance in improving the prognosis of patients with ACS.A large number of studies have shown that neutrophil to lymphocyte ratio(NLR)is closely related to atrial fibrillation(AF),coronary heart disease(CHD),hypertension(HP),heart failure(HF),and ventricular remodeling.However,few studies are focusing on the relationship between GRACE score,cardiac function and prognosis in patients with acute coronary syndrome(ACS).our study focused on the correlation between neutrophil-to-lymphocyte ratio(NLR),GRACE score and cardiac function,and analyzing the value of NLR,GRACE score and NLR combined with GRACE scores for prognostic evaluation in patients with acute coronary syndrome(ACS),by exploring the occurrence of major adverse cardiac events(MACE)within 6 months.MethodsThis article is a retrospective study,433 patients who were diagnosed with ACS and treated in the Second Affiliated Hospital of Zhengzhou University from January2015 to June 2018 were enrolled in our study.94 non-ACS patients at the same time were selected as the control group.the ACS group was subdivided into low-risk group(? 88 points)134 cases,medium-risk group(89-118 points)137 cases,high-risk group(>118 points)163 cases depending on the GRACE score;Basic information of all patients,including gender,age,height,weight,blood pressure,heart rate,smoking history,diabetes,congestive heart failure history and PCI history were collected.results from patients one week before hospital discharge were collected,including TC,LDL-C,TG,HDL-C,and fasting blood glucose(FBG),myocardial enzymes,myocardial markers,cardiac function markers,EF,LVDD.The median of NLR was calculated,then the NLR was subdivided into high NLR group and low NLR group according to the median.Pearson correlation test was used to analyze the correlation between NLR and cardiac function markers,left ventricular end-diastolic diameter and left ventricular ejection fraction.One-way ANOVA was used to analyze NLR in low-risk group,intermediate-risk group,high-risk group and control group.The ROC was used to analyze the value of NLR,GRACE score,NLR combined with GRACE score analysis in the prognosis of patients with ACS.Results1.Comparison of basic data of all patients,GRACE score were low risk group,middle risk group,high risk group and control group.There were no significant differences in basic data of gender,age,BMI,smoking status,diastolic blood pressure,TC,LDL-C,TG,cystatin in the four groups(all P> 0.05);while diabetes detection rate,systolic blood pressure,heart rate,adverse cardiac events,GRACE score,neutrophil to lymphocyte ratio,red blood cell distribution width,cardiac function markers,left ventricular end-diastolic The difference of inner diameter,left ventricular ejection fraction and high-sensitivity C-reactive protein were statistically significant(all P < 0.05),and the high-risk group was higher than the middle-risk,low-risk,control group,and the middle-risk group was higher than the low-risk group and the control group,for left ventricular ejection fraction,the high-risk group was lower than the middle-risk group,the low-risk group,and the control group,and the middle-risk group was lower than the low-risk group and thecontrol group.2.There was no statistical difference in gender composition,age,smoking status,body mass index,diastolic blood pressure,HDL,heart rate,systolic blood pressure,TC,LDL,cystatin C and triglyceride levels in patients between low NLR and high NLR(P>0.05);Diabetes detection rate,MACE event rate,GRACE score,red blood cell distribution width,cardiac function markers,LVEF,LVDD and high-sensitivity C-reactive protein were higher in high NLR group than low NLR group,and LVEF was lower than that in the low-NLR group(P<0.05).3.NLR was positively correlated with GRACE score,cardiac function markers,left ventricular diastolic end-stage diameter,(r=0.360),0.292,0.337,P <0.05),while NLR was negatively correlated with left ventricular ejection fraction(r=-0.369,P <0.05),no correlation was observed between NLR and triglycerides,cystatin C.4.91 cases developed MACE within 6 months in ACS group.NLR,GRACE score,NLR combined with GRACE score predicts that the AUC of MACE in patients with ACS within 6 months of onset is 0.770,0.803,0.858.NLR combined with GRACE score predicts the AUC of MACE within 6 months was Greater than NLR,GRACE score with significant difference(P <0.05).Conclusion1.The NLR of patients with ACS is significantly higher than that of normal people.2.Patients with high GRACE score in ACS patients and those with low NLR levels in intermediate-risk patients were significantly elevated.3.NLR were positively correlated with GRACE score,NT-proBNP,left ventricular end-diastolic diameter,and negatively correlated with left ventricular ejection fraction.4.The ROC curve was drawn.NLR combined with GRACE score predicted that the AUC of the MACE event occurred within 6 months of the ACS patients was greater than the NLR and GRACE score alone.