The Predictive Value Of MHR And MPV For The Major Adverse Cardivascular Events In Patients With AMI Undergoing PCI

Objective:The ami of the study was to find the relationship between monocyte count/ high density lipoprotein cholesterol(HDL-C)ratio(MHR)and mean platelet volume(MPV)levels in acute myocardial infarction(AMI)patients with major adverse cardivascular events(MACE)during hospitalization after percutaneous coronary intervention(PCI)andto explore the risk factors contributing to the occurrence of MACE.Methods:1.A total of 226 AMI hospitalized patients who were admitted to the department of cardiology of our hospital and treated with PCI from May 2017 to September 2018 were collected.Collecting selected cases of sex,age,medical history,routine blood test,blood biochemistry level and coronary angiography results and other related factors,combined with in-hospital MACE,the object of study is divided into the non-MACE group(192 cases)and the MACE group(34 cases),using the single factor analysis and multifactor analysis to analyze the serum level of MHR,MPV,Gensini score,and other related factors on the difference between the non-MACE group and MACE group.2.The correlation between MHR,MPV and Gensini score was analyzed to determine the relationship between them and the severity of coronary artery lesions.3.Patients were divided into the first,second,third and fourth quartile groups according to the quartile level of the two serum indicators,and the difference in the incidence of MACE among the groups was analyzed,and the diagnostic value of MHR,MPV and the combination of them for the occurrence of MACE was determined by Receiver-operating characteristic(ROC)curve.Results:1.The mean hospitalization time of all patients was 15±3.2 days,a total of 34 patients(15.04%)developed MACE,including 10 cases of recurrent angina,4 cases of infarction extension,8 cases of atrial fibrillation,3 cases of ventricular tachycardia,3 cases of ventricular fibrillation,2 cases of sinus arrest,3 cases of high atrioventricular block,and 1 case of death.2.Univariate analysis of data showed no significant difference in gender,hypertension,diabetes(DM),smoking,family history of coronary heart disease,and the type of myocardial infarction between the non-MACE group and the MACE group(P>0.05).The comparison of serum indexes between the two groups showed that the MACE group had higher serum,triglyceride(TG),serum creatinine(SCr),troponin T(cTnT)and fasting levels than the non-MACE group,while the HDL-C concentration was lower than the non-MACE group,but the difference was not significant(P>0.05).The age,total cholesterol(TC),low-density lipoprotein(LDL-C),monocyte count(Mo),MHR,MPV and Gensini score were significantly higher in the MACE group than the non-MACE group(P<0.05).3.Multivariate analysis of the occurrence of MACE: Multivariate Logistic regression analysis of age,TC,LDL-C,MHR,MPV and Gensini score was performed.The results showed that there were no significant differences between the two groups in TC,LDL-C(P>0.05),and there were significant differences between the two groups in age(OR=1.066,95% CI: 1.022~1.113),MHR(OR=9.415,95% CI: 1.837~48.241),MPV(OR=1.567,95% CI: 1.100~2.231)and Gensini score(R=1.098,95% CI: 1.0453~1.1541)(P<0.05).4.Correlation analysis of MHR and MPV with Gensini score: both MHR and MPV were positively correlated with Gensini score(P<0.05).5.The incidence of MACE in the quartile array with different MHR and MPV levels: along with the increase of baseline MHR and MPV levels,the incidence of MACE presented a gradually increasing trend with significant differences(P<0.05).6.The predictive value of MHR,MPV and the combination of them on the occurrence of MACE: MedCalc statistical software was used to draw ROC curve of MHR,MPV and their combined factors for the occurrence of MACE,and Z test was conducted.It was concluded that all of them have predictive diagnostic value for the occurrence of MACE.By pairwise comparison of the above factors under the line of the march,we analyzed whether there were differences in the diagnostic efficacy of the three factors on the occurrence of MACE.The results showed that the diagnostic value of MPV(the area under the curve reaching 0.711,the sensitivity 70.59% and the specificity 69.27%)was slightly higher than that of MHR(the area under the curve reaching 0.709,the sensitivity 61.76% and the specificity 73.96%),but there was no significant difference(P>0.05).Pairwise comparison between MHR,MPV and combined factors(the area under the curve reaching 0.788,the sensitivity 73.53% and the specificity 71.87%)showed that combined factors had higher predictive diagnostic value with significant difference(P<0.05).Conclusion:MACE risk during hospitalization after PCI in AMI patients can be predicted by MHR and MPV levels independently and effectively.When both of them are detected,the predictive efficacy is greater.