Predictive Value Of Mean Platelet Volume And Neutrophil Count For In-stent Restenosis After Drug-eluting Stents Implantation

Objective: To investigate the predictive value of mean platelet volume(MPV)and neutrophil count in in-stent restenosis(ISR)after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods: A total of 410 patients with coronary heart disease who were first implanted with drug-eluting stent(DES)in the first affiliated Hospital of Guangxi Medical University from January 2015 to December 2018 and returned to hospital for coronary angiography(CAG)8-24 months after operation are enrolled in this study.The clinical data,preoperative biochemical indexes and intervention data of the first PCI were collected,and the blood routine and intervention data were collected before reexamination of CAG.According to the results of CAG examination,whether restenosis occurred in 5mm or in the original stent near the stent,and the degree of stenosis was greater than or equal to 50% of the reference vessels,were divided into non-restenosis group(N-ISR group,350cases)and restenosis group(ISR group,60 cases).The general clinical data,biochemical indexes and intervention data of the two groups were compared.Binary Logistic regression analysis was used to analyze the risk factors of ISR.The predictive value of MPV and neutrophil count to ISR was analyzed by drawing the ROC of MPV and neutrophil count to predict ISR.Results: A total of 410 patients with coronary heart disease were selected,of which 60 patients developed ISR,with an incidence of14.6%.(1)General clinical data: There was no significant difference in age,weight,height and sex between N-ISR group and ISR group(P>0.05),but the proportion of patients with diabetes mellitus in ISR group was significantly higher than that in N-ISR group(P<0.05).(2)Biochemical index: Before stent implantation,there was no significant difference in white blood cell count,hemoglobin,platelet count,TC and LDL-C between N-ISR group and ISR group(P>0.05).But before stent implantation and before re-examination of CAG,MPV and neutrophil count in ISR group were significantly higher than those in N-ISR group(P<0.05).(3)Interventional data: There was no significant difference between N-ISR group and ISR group in the presence of left main artery disease,the number of diseased vessels before operation(single,double and three branches),and whether or not to use IVUS guidance(P>0.05).However,the number of stents implanted and the use of series stents in ISR group were significantly higher than those in N-ISR group(P<0.05).(4)Binary Logistic regression analysis: Before stent implantation and before reexamination of CAG,the results suggested that MPV and the number of neutrophils were independent risk factors for ISR(P<0.05).(5)Drawing the ROC curve of MPV and neutrophil count to predict ISR:Before stent implantation,MPV predicted that the AUC of ISR was0.614(95%CI 0.538-0.691,P=0.005<0.05),and the best cut-off value of MPV for predicting ISR is 8.43,with a sensitivity of 65.0% and a specificity of 56.0%.The AUC of ISR predicted by neutrophil count was 0.594(95%CI 0.518-0.671,P=0.019<0.05),and the best cut-off value for predicting ISR by neutrophil count was 4.24,with a sensitivity of 68.3% and a specificity of 50.0%.Before rechecking CAG,MPV predicted that the AUC of ISR was 0.602,and the best cut-off value was 8.41,the sensitivity was 63.3%,and the specificity was 60.0%.The AUC of neutrophil count predicted ISR was 0.608,and the best cut-off value was 4.19,sensitivity was 70.0%,and specificity was 51.4%.(6)The predictive value of combined MPV and neutrophil count to ISR: Before stent implantation,when MPV and neutrophil count took the best cut-off value,the sensitivity and specificity of MPV and neutrophil number sequence test to predict ISR were 43.3%and 78.3% respectively,and the sensitivity and specificity of parallel test prediction were 90% and 27.4% respectively.Before reexamining CAG,the sensitivity and specificity of MPV and neutrophil sequence test for predicting ISR were 41.7% and 79.7% respectively,while those of parallel test were 91.7% and 31.7% respectively.Conclusion: MPV and neutrophil count can predict the occurrence of ISR after PCI in patients with CHD.