The Correlation Between NLR And Coronary Artery Lesions In STEMI Patients And The Predictive Value For In-Hospital MACE After Emergency PCI

Aim:To analyse the relationship between the preoperative neutrophils lymphocyte ratio(NLR)and the severity of coronary lesions in STEMI patients underwent the emergency percutaneous coronary intervention(PCI).and to investigate the difference between preoperative NLR and postoperative NLR.To compare and evaluate either of preoperative NLR and postoperative NLR is valuable in predicting major adverse cardiovascular events(MACE)in hospital for patients with STEMI.Subjects and methods:A total of 191 patients with STEMI because of "chest pain(< 12 hours)" underwent coronary angiography and emergency PCI from January 1,2018 to October 1,2019 in the center of the Yiyang Central Hospital and were continuously enrolled in this study.There were 144 male patients and 47 female patients,with an average age of 62.3±12.4.We recorded all the clinical data of patients,including basic information 、hematology indexes results 、 ultrasonic cardiogram results and coronary angiography results.According to the median of Gensini score(GS),subjectswere divided into low GS group(GS<80)(95 cases)and high GS group(GS≥80)(96 cases).During the follow-up,subjects were divided into the MACE group(40 cases)and the non-MACE group(151 cases)according to the occurence of MACE.Differences in clinical data between the two groups were compared.Using multi-factor binary Logistic regression analysis,we investigate the relationship between the preoperative NLR/postoperative NLR and the MACE occurence in hospital,and discusse the differences between preoperative NLR and postoperative NLR.The blood routine examinations(the number of white blood cell(WBC),neutrophil percentage(N%),lymphocyte percentage(L%),NLR)were compared between the MACE group and the non-MACE group.The ROC curve was used to analyze the predictive value of the preoperative and postoperative NLR in major adverse cardiac events after emergency PCI in STEMI Patients in hospital.Result:1.Between the high GS group and the low GS group,the NLR in the high GS group was significantly higher than that in the low GS group.There were statistically significant differences between the two groups in the history of hypertension,history of smoking,history of diabetes,LVEF,preoperative N%,preoperative L%,preoperative NLR,TG,TC and NT-proBNP(P < 0.05).2.Spearman rank correlation results showed that preoperative NLR was positively correlated with Gensini score(r=0.550,p<0.001).3.There were statistically significant differences in age,NT-proBNP,Gensini score and LVEF between the MACE group and the non-MACE group(P<0.05).The differences of preoperative WBC,N% and postoperative WBC,N%,L% and NLR between the two groups were statistically significant(P<0.05).The preoperative WBC and N% in the MACE group were higher than that in the non-MACE group.At the same time,the postoperative WBC,N% and NLR in the MACE group were significantly higher than that in the non-MACE group,and the postoperative L% were significantly lower than that in the non-MACE group.4.The postoperative NLR in the MACE group was higher than that before surgery,and L% was lower than that before surgery(P<0.001).However,the WBC,N% and NLR in the non-MACE group significantly decreased,but L%increased(P<0.001).5.Multivariate binary Logistic regression analysis showed that age,LVEF,Gensini score,nt-proBNP,and postoperative NLR were risk factors for MACE events in the hospital after emergency PCI for STEMI patients(P<0.05).After adjusting for associated risk factors,postoperative NLR was an independent predictor of in-hospital MACE events in STEMI patients after emergency PCI(OR=0.472,95%CI: 0.337-0.66,P<0.001).6.ROC curve analysis showed that the area under the ROC curve was 0.533(95%CI: 0.449-0.618,P=0.519)when preoperative NLR predicted the MACE happening in patients with STEMI,the optimal cut-off point was 7.850,thesensitivity was 80.0%,the specificity was 43.0%,and the yodan index was0.230.When postoperative NLR predicted the MACE happening,the area under the ROC curve was 0.936(95%CI: 0.902-0.97,P<0.001),the optimal cut-off point was 9.420,the sensitivity was 90.0%,the specificity was 87.4%,and the youten index was 0.774.Conclusions: 1.Preoperative NLR of STEMI patients undergoing emergency PCI is positively correlated with the degree of coronary artery lesions.2.The presence of increased neutrophil count,decreased lymphocyte count and high NLR after emergency PCI in STEMI patients has certain predictive value for the occurrence of in-hospital MACE events.