| BackgroundAcute coronary syndrome(Acutecoronarysyndrome,ACS)is a common serious cardiovascular disease,common in older men and postmenopausal women,its characteristic is quick,condition change fast and case fatality rate is high,the ACS is mainly composed of coronary atherosclerotic plaque rupture suddenly,fall off caused by blocked blood vessels,If not treated in time,it can lead to heart failure,recurrent heart failure and even sudden death[1].Although coronary intervention technology continues to advance,but the prognosis of ACS is still not optimistic,undergoing percutaneous coronary intervention(PercutaneousCoronarylntervention,PCI)in patients,some patients will still appear arrhythmia,such as postoperative recurrence infarction cardiovascular adverse events(MACE).Atherosclerosis is the main cause of acs.Previously,atherosclerosis has been considered as a multifactorial disease,with pathogenesis including dyslipidemia,dysglycemia,smoking and other causes of endothelial injury,and genetic susceptibility[2-3].However,in recent years,studies have shown that inflammation plays an important role in the occurrence and-development of atherosclerosis[4].Platelets/LymphocyteRatio(PLR)and Neutrophil/LymphocyteRatio(NLR),as inflammatory indicators,have been confirmed to be closely related to the occurrence and development of coronary heart disease[5-7].These results suggest that the level of inflammatory indicators has a certain influence on the relationship between coronary intervention therapy and prognosis of patients with ACS,which can help clinicians classify high-risk ACS patients after PCI and give corresponding drugs to prevent the occurrence of MACE,improve the life expectancy and quality of life of patients,and save medical resources.ObjectiveTo investigate the short-time prognosis of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients with acute coronary syndrome after PCI.Methods508 patients who met the diagnostic criteria of acute coronary syndrome and underwent coronary intervention in the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2021 were collected continuously,129 healthy people were collected in the same period,508 patients with acute coronary syndrome were taken as the research object(ACS group),and 129 healthy people in the same period were taken as the control group,At least two cardiovascular physicians with rich experience in coronary intervention independently analyzed the results of coronary angiography,suggesting that at least one main coronary artery(right coronary artery,left anterior descending artery and circumflex artery)had lesions,and met the PCI Treatment Standard of China guidelines for percutaneous coronary intervention(2016).The baseline data of the two groups were collected.The main adverse cardiovascular events(MACE)6 months after PCI in patients with acute coronary syndrome were collected by querying the outpatient reexamination data and follow-up system inquiry.Mace is defined according to the New York Heart Association as target vessel revascularization,in stent restenosis,myocardial infarction or cardiac death[6].The baseline data of the two groups were compared.The risk factors of mace after PCI in patients with ACS were analyzed by univariate and multivariate logistic regression model.The value of PLR and NLR and their combination in predicting acute coronary syndrome and mace after ACS were analyzed by ROC curve.All data were analyzed by spss26 0 software for statistical analysis.Results1.There were 508 cases in the acute coronary syndrome group and 129 cases in the control group.There was no significant difference between the two groups in gender,age,history of hypertension,history of diabetes,history of smoking,family history of coronary heart disease,total cholesterol,low density lipoprotein,abnormal liver function and blood uric acid(all P>0.05).2.The values of platelets,neutrophils,serum creatinine,PLR and NLR in the acute coronary syndrome group were higher than those in the control group,while HDL,lymphocytes and LVEF were lower than those in the control group(all P<0.05).3.The sensitivity of PLR in predicting ACS was 75.20%,the specificity was 70.50%,the best cutoff point was 127.81,and the area under the curve(AUC)was 0.776[95%CI:0.731-0.822,P=0.026].The sensitivity and specificity of NLR in predicting ACS were 66.3%,86.80%,2.95 and 0.822[95%CI:0.788-0.857,P=0.024].The sensitivity of PLR combined with NLR in predicting ACS was 77.80%,the specificity was 84.50%,and the AUC was 0.886[95%CI:0.857-0.915],P=0.027].4.The occurrence of mace in ACS patients after operation was taken as the dependent variable,and the independent variables were age,gender,smoking history,history of hypertension,history of diabetes,family history of coronary heart disease,total cholesterol,low-density lipoprotein,abnormal liver function,blood uric acid,blood creatinine,platelet,neutrophil,PLR,NLR,high-density lipoprotein,lymphocyte and LVEF.5.Eight factors including HDL,platelet,neutrophil,lymphocyte,LVEF,serum creatinine,PLR and NLR were included in the multivariate logistic regression model.The results showed that PLR and NLR were independent risk factors for mace after PCI in patients with ACS(P<0.05).6.The sensitivity of PLR in predicting mace after ACS was 63.00%,the specificity was.80.30%,the cut-off value was 158.76,and the AUC was 0.781 95%CI:[0.728-0.834,P=0.026].NLR predicted mace in ACS patients with sensitivity of 72.80%,specificity of 61.40%,AUC of 0.723[95%CI:0.670-0.777,P=0.028],and cut-off value of 3.36.When PLR>158.76,the incidence of mace was 15.43%.When PLR<158.76,the incidence of mace was 7%.The incidence of the former was higher than that of the latter,and the difference was statistically significant(χ2=6.055,P=0.014);When NLR>3.36,the incidence of mace was 20.18%,When NLR<3.36,the incidence of mace was 0.67%.The incidence of the former was significantly higher than that of the latter,and the difference was statistically significant(χ2=13.619,P<0.001)。The sensitivity of PLR combined with NLR in predicting mace was 84.00%,the specificity was 73.50%,and the AUC was 0.849[95%CI:0.808-0.891,P=0.029].The sensitivity and area under the curve were greater than that of single prediction,and the joint prediction was better than that of single detection.ConclusionPLR and NLR are the risk factors of mace after PCI in patients with acute coronary syndrome and ACS.The combination of PLR and NLR can predict the short-term mace after PCI in patients with acute coronary syndrome to a certain extent,which is helpful to the stratification of short-term prognosis after PCI in patients with acute coronary syndrome. |
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