NLR Combined With MPV Was Used To Predict The No-reflow And Short-term Prognosis Of Acute STEMI Patients After PCI

Objective:To explore the predictive value of neutrophil to lymphocyte ratio(NLR)combined with mean platelet volume(MPV)in the occurrence of no reflow and short-term major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:From June 2018 to December 2019,627 patients who were diagnosed as STEMI and underwent emergency PCI at the first affiliated hospital of Shihezi university school of medicine were selected.According to the prediction of short-term MACE by peripheral blood NLR and MPV at admission,the patients were divided into four groups: low NLR and low MPV group(NLR?3.13 and MPV?11.15/fl,n=216),low NLR and high MPV group(NLR?3.13 and MPV>11.15/fl,n=145),high NLR and low MPV group(NLR>3.13 and MPV?11.15/fl,n=168),high NLR and high MPV group(NLR>3.13 and MPV>11.15/fl,n=98).According to the incidence of no reflow after PCI,the patients were divided into no reflow group(n=152)and normal blood flow group(n=475).According to the incidence of short-term MACE,the patients were divided into two groups: the group with mace(n=63)and the group without mace(n=564).According to the global acute coronary syndrome registration score(GRACE score),it was divided into low-risk group(GRACE score?108 points,119 cases),medium-risk group(108 points<GRACE score?140,203 cases),and high-risk groups(GRACE score>140 points,305 cases).Compare baseline characteristics,laboratory data,culprit vessels of coronary angiography,and medication after PCI in patients with different levels of NLR combined with MPV,no-reflow and normal blood flow,patients with and without MACE;Compare the NLR and MPV levels before PCI in patients with different GRACE score groups;evaluate the correlation between NLR and MPV before PCI;use Logistic regression analysis to explore the independent influencing factors of no reflow after PCI in STEMI patients;use Cox regression analysis To explore the independent influencing factors of short-term MACE in patients with STEMI after PCI;The receiver operating characteristic curve(ROC curve)was used to evaluate and compare the predictive efficacy of NLR,MPV,and NLR combined with MPV on STEMI patients without reflow and short-term MACE after PCI;Kaplan-Meier method was used to compare the cumulative MACE-free survival rates of patients in different NLR,MPV,and NLR combined MPV groups.Results:High NLR and MPV group patients age and GRACE score on admission,heart failure caused by acute myocardial infarction(Killip class II or higher),neutrophil counts,MPV,NLR,cardiac troponin T(cTnT)peak,N-terminal brain natriuretic peptide precursor(NT-ProBNP)is significantly higher than the other three groups,and lymphocyte count,left ventricular ejection fraction(LVEF)was significantly lower than the rest of the three groups,the difference had statistical significance(P<0.05).The levels of NLR and MPV in high risk group were higher than those in middle risk group and low risk group(P<0.05).There was a positive correlation between NLR and MPV in STEMI patients before PCI(rs=0.156,P<0.01).Multivariate logistic regression analysis showed that NLR(odds ratio(OR): 1.378,95% confidence interval(CI): 1.073-1.493,P<0.01),MPV(OR: 1.271,95% CI:1.019-1.586,P=0.033)were independent risk factors for no-reflow in STEMI patients after PCI.Multivariate Cox regression analysis showed that NLR(hazard ratio(HR):1.489,95% CI: 1.293-1.654,P<0.01)and MPV(HR: 1.868,95% CI: 1.533-2.962,P<0.01)were independent risk factors for MACE in STEMI patients after PCI.Kaplan Meier curve analysis showed that the incidence of mace in high NLR and high MPV group was significantly higher than the other three groups(high NLR and high MPV vs high NLR and low MPV vs low NLR and high MPV vs low NLR and low MPV;18.37% vs 10.71% vs 10.34% vs 5.56%,P<0.01).The results of AUC showed that NLR combined with MPV had a significantly higher predictive effect on no reflow(AUC: 0.721,95% CI: 0.659-0.783)and short-term mace(AUC: 0.796,95%CI: 0.741-0.851)after PCI than NLR and MPV.Conclusion:In the early stage of admission,NLR and MPV increased with the increase of GRACE risk stratification,and NLR and MPV showed a weak but significant positive correlation;High NLR and high MPV are independent risk factors for no reflow and short-term mace in STEMI patients after PCI.NLR combined with MPV can more efficiently predict the occurrence of non-reflow and short-term MACE,which may be a new biological indicator applied to the prognosis assessment of emergency early STEMI patients.