| Objective:Acute ST-segment elevation myocardial infarction(STEMI)is a common clinical cardiovascular disease with high morbidity and mortality,which seriously threatens the life and health of patients.The elderly patients with STEMI are in a state of chronic low-grade inflammation due to the decline of adaptive and innate immune function,malnutrition and type 2 diabetes.The inflammatory response of the elderly patients is significantly higher than that of the young patients on admission,and the in-hospital,short-term and long-term mortality of the elderly patients are higher.Therefore,early screening and identification of high-risk patients and early clinical intervention are essential for saving patients’ lives and improving their prognosis.The aim of this study is to investigate the Monocyte/high-density lipoprotein ratio(MHR),Systemic immune inflammation index(SII),and monocyte/high-density lipoprotein ratio(MHR)and short-term poor prognosis in elderly patients with acute STEMI treated with primary Percutaneous coronary intervention(PCI).And the predictive value of SII combined with MHR for Major adverse cardiovascular events(MACE)in elderly patients with STEMI during hospitalization.Methods:Elderly patients with STEMI who were hospitalized and underwent primary PCI in the Department of Cardiology of Hebei General Hospital from January 1,2017 to October 31,2020 were retrospectively analyzed.Patients were continuously screened according to the exclusion and inclusion criteria strictly,and a total of 628 patients were finally included.Through the electronic management system of the hospital’s medical records,the relevant baseline data of the patients,the operation related data and the postoperative medication were collected,and the required clinical data were calculated according to the formula.The elderly patients with STEMI were divided into the non-MACE group(n=546)and the MACE group(n=82)according to the presence or absence of in-hospital MACE events.Chi-square tests were used for all categorical variables.Normally distributed continuous variables were statistically analyzed by t test,and non-normally distributed continuous variables were statistically analyzed by Mann-Whitney U test.Variables with P<0.05 were selected and included in binary Logistic regression to analyze the independent risk factors for in-hospital MACE.The Receiver operating characteristic curve(ROC)was used to further evaluate the predictive efficacy of SII,MHR and their combination for MACE events in elderly patients with STEMI during hospitalization.De Long test was performed using Medcalc15.6 to compare the differences in predictive power among the three predictors.Results:1.Compared with the non-MACE group,the history of diabetes,intraoperative no-reflow,NC,smoking history,WBC,SUA,MO,SII and MHR in the MACE group were higher,while LVEF,e GFR and LC were lower(P<0.05).2.Multivariate Logistic regression analysis showed that smoking history,diabetes history,SII,no reflow during operation,and MHR were independent influencing factors for in-hospital MACE in elderly STEMI patients after primary PCI(P<0.05).3.The results of ROC curve showed that SII and MHR both had certain predictive ability for MACE in elderly STEMI patients during hospitalization,but the combined predictive ability of SII and MHR was higher(the area under the curve was 0.773),which could better predict in-hospital MACE events.4.De Long test was performed using Medcalc15.6 software to compare the predictive value of SII,MHR and their combined predictors for in-hospital MACE.The results showed that compared with SII and MHR,the combined predictor had higher predictive efficiency for in-hospital MACE.Conclusions:1.History of diabetes,no-reflow,smoking history,SII and MHR are independent risk factors for in-hospital MACE in elderly STEMI patients undergoing primary PCI.2.Both SII and MHR have certain predictive value for in-hospital MACE events in elderly patients with acute STEMI after PCI.Compared with SII and MHR alone,the combination of the two can better predict in-hospital MACE. |
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