Study On The Effects Of Nicorandil,NEU And NLR On In-hospital MACE After PCI In Patients With Acute STEMI

Objective:To investigate the effects of intravenous pumping of nicorandil,NEU and NLR on MACE events after percutaneous coronary stenting in patients with acute ST-segment elevation myocardial infarction.Methods:A total of 180 patients with acute ST-segment elevation myocardial infarction admitted to the Chest Pain Center of Affiliated Hospital of Guizhou Medical University from June 2019 to June 2022 who met the study conditions were retrospectively collected.According to the occurrence of MACE events during hospitalization,there were 52 cases in the group with MACE events and 128 cases in the group without MACE events.General data of each group were collected: gender,age,body mass index(BMI),combined hypertension,diabetes,combined dyslipidemia,combined smoking history,combined drinking history;Clinical data of the two groups were collected: Cardiac function at admission(Killip grade),coronary artery of the crime,number of lesions,time from onset to vessel opening of the offender,whether nicoladil injection was injected intravenously for 24 hours within half an hour after surgery,length of stay,preoperative blood routine indicators(white blood cells(WBC),neutrophil absolute value(NEU),lymphocyte absolute value(LYM),and red blood cells Distribution width(RDW),platelet count(PLT),NLR(ratio of absolute neutrophils to lymphocytes),PLR(ratio of platelet count to lymphocytes).The general data,clinical data and relevant indicators in blood routine were analyzed and processed by SPSS 25.0 statistical software.The measurement data conforming to normal were expressed as(X±S),while the measurement data incompatible with normal were expressed as median(P25,P75).The T-test was used when the variance was equal.Non-parametric test was used when variances were inconsistent,and counting data was represented by rate(%).Binary Logistic regression was used to screen out the risk factors related to MACE events after PCI in acute STEMI patients,and the ROC curve of related risk factors predicting the occurrence of MACE after PCI in acute STEMI patients was drawn.The accuracy and sensitivity of predicting the occurrence of MACE in patients with nicodil injection,leukocyte,neutrophilic granulocyte absolute value,NLR,PLR,etc.,were analyzed within half an hour after surgery.P < 0.05 was considered statistically significant.Results:1.Comparison of general data The age of the MACE group was greater than that of the group without MACE,and the difference between the groups was statistically significant(P<0.05).2.Comparison of clinical data The proportion of patients with MACE stage 1-2(Killip grade)and the proportion of intravenous pumping of nicorandil injection for 24 hours within half an hour after surgery were lower than those in the group without MACE(P<0.05),and the proportion of cardiac function grade 3(Killip grade),the proportion of cardiac function grade 4(Killip grade),and the proportion of criminal coronary RCA in the MACE group were higher than those in the group without MACE,the difference between the two groups was statistically significant(P<0.05).3.Results NEU,NLR and PLR in the group with MACE were higher than those without MACE,and the differences between the two groups were statistically significant(P < 0.05).4.Logistic regression analysis of risk factors after PCI in acute STEMI patients Independent risk factors after PCI in acute STEMI patients were cardiac function(Killip scale)(OR: 3.632,95%CI:2.087-6.320),NEU(OR:1.246,95%CI: 1.061～1.463),NLR(OR: 1.142,95%CI: 1.039～1.254);The independent protective factor for acute STEMI patients after PCI was intravenous infusion of nicodil injection(OR:0.417,95%CI: 0.176-0.988)starting within half an hour after PCI for 24 hours.5.ROC curve analysis of single and combined indexes of NEU and NLR showed that the AUC of NEU was the largest,which was 0.662.8.87 was selected as the limit value,with sensitivity of 53.8% and specificity of 71.9%.The AUC of NLR was0.653 and 3.58 was selected as the limit value.The sensitivity was 94.2% and the specificity was 38.8%.In pairwise combination,the AUC of NEU and NLR was0.672,the sensitivity was 65.4%,and the specificity was 61.7%.Conclusions:1.Cardiac function(Killip grade),absolute neutrophil value,and NLR are independent risk factors for MACE after PCI in patients with acute STEMI,and pumping nicorandil is an independent protective factor after PCI in patients with acute STEMI.2.NLR and NEU are related to MACE after PCI in patients with acute ST-segment elevation myocardial infarction,and the combination of NLR and NEU has good predictive performance,when the NLR value in venous blood routine ≥ 3.58 or NEU ≥ 8.87,it indicates that the risk of in-hospital MACE is increased,and patients need to be alert to the possibility of malignant arrhythmia and shock.