| Objective:To research the relationship between the ratio of neutrophil to lymphocyte(NLR),sleep disorder and the prognosis in patients with non-ST-elevation acute coronary syndrome(NSTE-ACS)undergoing elective percutaneous coronary intervention(PCI)within 1 year.Methods:A total of 231 NSTE-ACS patients after PCI were collected from January 2015 to November 2017 in the First People’s Hospital of Changshu Hospital,followed-up after postoperative 1 years.The clinical data of all patients after admission were collected,including age,gender,BMI,history of hypertension,history of diabetes,history of coronary heart disease,history of smoking and the drugs after PCI.Physical examination,measure height and weight and calculate body mass index were completed in admission;The electrocardiogram,dynamic electrocardiogram,transthoracic heart ultrasound,blood routine(including preoperative blood routine,postoperative blood routine within 24 hours and postoperative blood routine between 24 hours and 1 month)were collected,Whether left main stem,three-vessel lesion and bifurcation lesion,the number of stents,total length of stents,and average diameter of stents were obtaining after PCI.CKMB and cTnI were continuously collected at 6,12,18 and 24 hours after PCI.The enrolling patients filled out the Pittsburgh sleep quality index(PSQI)in the outpatient department after one month.Results:231 patients with NSTE-ACS who underwent elective PCI were followed up,214 cases were received the clinical follow-up successfully,and 17 cases were lost,with a follow-up rate of 92.6%,including 148 males(69.2%)and 66 females(30.8%),aged 66.16±8.16 years.Among the follow-up patients,32 cases(15.0%)had MACCE events,and 182 cases(85.0%)had no MACCE events.1.Compared with non-MACCE group,patients in MACCE group were older(70.788.00vs65.48 8.11),preoperative neutrophil count,preoperative INR,postoperative 24-hour NLR,postoperative 24-hour INR,three-vessel lesion ratio and total PSQI score were significantly higher than those in non-MACCE group which were(4.83±1.90 vs4.07±1.41)、(4.23±2.36vs2.79±1.34)、(5.97±3.03vs4.37±2.36)、(3.72±1.14vs3.03±1.70)、(37.5%vs13.7%)、(12.81±2.75vs11.18±2.84)respectively.Lymphocyte count before operation,lymphocyte count within 24 hours after operation,lymphocyte count more than 24 hours after PCI and LVEF were lower than those in non-MACCE group,which were(1.28±0.41vs1.65±0.66)、(1.03±0.29vs1.38±0.54)、(1.26±0.53vs1.44±0.48)、(59.06±6.11vs63.48±7.17),respectively.Multivariate logistic regression analysis showed that preoperative NLR,postoperative NLR,PSQI,age,and LVEF values were independent risk factors for MACCE in NSTE-ACS patients within 1 year after elective PCI.2.The area under the ROC curve of the preoperative NLR for MACCE was 0.72(95%CI 0.625-0.814),and the optimal cutoff value of preoperative NLR predicting one-year MACCE was 2.918(sensitivity:68.8%,and specificity:77%).3.The area under the ROC curve of the postoperative NLR within 24 hours after PCI for MACCE was 0.754(95%CI 0.686-0.822),and the optimal cutoff value of postoperative NLR within 24 hours after PCI predicting one-year MACCE was 4.32(sensitivity:90.6%,and specificity:64.8%).4.The area under the ROC curve of total PSQI was 0.666(95%CI 0.572-0.761)and and the optimal cutoff value of total PSQI score predicting one-year MACCE was nine(sensitivity:84.4%,and specificity:44.0%).Conclusion:1.There were significant differences between MACCE group and non-macce group in age,preoperative neutrophil count,preoperative NLR,postoperative NLR within 24 hours,postoperative NLR more than 24 hours,proportion of three-vessel lesions,total score of PSQI,preoperative lymphocyte count,postoperative lymphocyte count within 24 hours,postoperative lymphocyte count more than 24 hours and LVEF.Multivariate logistic regression analysis showed that preoperative NLR,postoperative NLR,PSQI,age,and LVEF values were independent risk factors for MACCE in NSTE-ACS patients within 1 year after elective PCI.2.Compared with preoperative NLR,NLR within 24 hours after PCI has a stronger ability to predict MACCE in NSTE-ACS patients within 1 year after elective PCI,and the total score of PSQI has certain predictive value for MACCE in NSTE-ACS patients within 1 year after elective PCI. |
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