The Relationship Between MHR And Severity Of Coronary Artery Lesions And Short-term Prognosis In Patients With Acute ST Elevation Myocardial Infarction

Background and ObjectiveAcute ST segment elevation myocardial infarction(STEMI)is the main type of acute myocardial infarction(AMI),It refers to on the basis of coronary artery lesions,the main cause is acute thrombosis in the lumen due to coronary atherosclerotic plaque rupture,coronary artery occlusion occurs continuously and completely,blood supply is sharply reduced or interrupted,this leads to the corresponding myocardial necrosis resulting from severe and persistent acute ischemia.The disease progressed rapidly,the incidence is increasing year by year,and it has a high fatality rate.Monocytes promote inflammation and oxidation,But HDL plays a role as a reversal factor in these processes.Recent studies have found that Monocyte/high density lipoprotein cholesterol(MHR)is a new marker associated with inflammation and oxidative stress,It is closely related to cardiovascular disease,the clinical value of evaluating the severity and short-term prognosis of coronary artery disease in STEMI patients has not been determined.This study analyzed the relationship between MHR of STEMI patients and Gensini score and Major adverse cardiovascular events(MACE)within six months of discharge.Materials and Methods1.Subjects of study:analysis of 265 STEMI patients hospitalized in the department of cardiovascular medicine of the second affiliated hospital of zhengzhou university who underwent Percutaneous coronary intervention(PCI)from January 2018 to December 2018.There were 69 females(26.0%)and 196 males(74.0%),The mean age of the patients was 58.94±11.06 years,and the mean BMI was 27.43±4.47 kg/m2.General information,examination results within 24 hours of admission,adverse cardiovascular events within 6 months of discharge and coronary angiography results were collected,the Gensini score was calculated according to the results of coronary angiography.2.Statistical methods:SPSS22.0 software was used for statistical analysis.The counting information is expressed as a percentage,X2 test was used for comparison between groups.The measurement data of normal distribution were expressed as mean±standard deviation(x±s),Independent sample t test was used to compare the two groups;One-way ANOVA was used for comparison among groups;Non-normally distributed measurement data are represented by median and quartile[M(P25,P75)],The kruskal-wallis H test was used for inter-group comparison.Pearson was used for correlation analysis,Cox regression analysis was performed for each possible prognostic variable,The effect of the MHR tertiles on survival was expressed as a kaplan-meier curve,Log Rank was used for comparison of survival curves.The sensitivity,specificity and optimal cut-off value of MHR for predicting poor short-term prognosis were calculated by using the receiver operating characteristic(ROC)curve.P<0.05 was considered statistically significant.Results1.Comparison of basic clinical data among the three groups:There were no significant differences in age,sex,smoking histoiy,hypertension,diabetes,heart rate,Killip≥clas II,Pre-hospital medication status,Trocalin-T(cTn-T),creatine kinase isoenz yme(ck-mb),fasting blood glucose(FPG),glycosylated hemoglobin(HbAlc),crea tinine(Cr),triglyceride(TG),WBC,neutrophils(NEUT),lymphocytes(LY)in the high,medium and low MHR groups(P>0.05).For monocytes(Mon),hypersensitive c-reactive protein(hs-CRP),n-terminal natriuretic peptide(NT-proBNP),Pairwise com parisons between the three groups showed statistical differences(P<0.05).The BMI of the high level group was higher than that of the other three groups(P<0.05),However,there was no significant difference between the middle level group and the low level group.Compared with the low-level group,the high-level group and middle level group had higher cholesterol(TC)and low-density lipoprotein(LDL-C)and lower high-density lipoprotein(HDL-C)(P<0.05),while there was no significant difference between the high-level group and the medium-level group.2.MHR and coronary artery lesions:The numbers of coronary artery lesions were similar in the low,medium and high MHR groups.However,the pairwise difference of Gensini score among the 3 groups was statistically significant(high level group of MHR>middle level group of MHR>level group of MHR,P<0.05).Pearson correlation analysis showed that Mon was moderately positively correlated with Gensini score,HDL-C was weakly negatively correlated with Gensini score,and MHR was strongly positively correlated with Gensini score.3.MHR and short-term prognosis:All patients were divided into MACE group and non-mace group according to whether the STEMI patients developed MACE within 6 months,The results showed that the proportion of diabetes history and prehospital administration of beta blockers,Mon,hs-CRP,MHR,NT-proBNP,TC,and LDL-C in MACE group were higher than those in Non-mace group,and the high-density lipoprotein(HDL-C)was lower than in the Non-mace group,The difference was statistically significant(P<0.05).Whether or not MACE occurred in STEMI patients within 6 months(assignment:yes=1,no=0)was taken as the dependent variable,Multivariate COX regression analysis was performed using diabetes history,prehospital administration of beta blockers,TC,HDL-C,LDL-C,hs-CRP,Mon,NT-proBNPand MHR as independent variables.The results showed that NT-proBNP(HR=1.003,95%CI:1.001～1.005),hs-CRP(HR=1.175,95%CI:1.033～1.337)and MHR(HR=2.396,95%CI:1.141～5.032)were independent risk factors for MACE in STEMI patients within 6 months of discharge.The cumulative mace-free survival curve of patients in the high-level MHR group was lower than that in the middle-level and low-level groups,and the difference was statistically significant(X2=2.652,P<0.001).4.Diagnostic performance of MHR:When the MHR was 1.556,its predictive value of recent adverse cardiovascular events in STEMI patients was the highest,with sensitivity of 70.1%and specificity of 77.8%,and area under ROC curve(AUC)of 0.799(95%CI:0.739,0.858).conclusion1.With the increase of MHR level,Gensini score increased significantly,MHR was positively correlated with the severity of coronary artery disease.2.MHR is an independent risk factor for recent adverse cardiovascular events in STEMI patients.It is of some clinical value to evaluate the short-term prognosis of STEMI patients with a cut-off value of 1.556.