Relationship Between MPVLR And No-reflow In Patients With Acute STEMI After Primary PCI

Objective: This study was to investigate whether the mean platelet volume to lymphocyte ratio(MPVLR)can be used to predict the occurrence of no-reflow after pPCI in patients with acute STEMI.Methods: A total of 152 patients diagnosed with STEMI were retrospectively analyzed who underwent pPCI from the green channel of the chest pain center to the catheter room in my hospital from September2017 to August 2018.According to the TIMI blood flow grade of Criminal blood vessel,these patients were grouped into two.After the vascular opening,the forward TIMI blood flow≤2 is no-reflow group(27 cases)and the forward TIMI blood flow level 3 is normal flow group(125 cases),comparing the statistical differences between the two groups.The ROC curve was used to evaluate the predictive value of MPVLR for coronary no-reflow.All patients were divided into high MPVLR group and low MPVLR group according to the optimal cut-point value,comparing whether the differences between the two groups of clinical data had statistical significance.Logistic regression models were used to verify whether MPVLR was independently associated with no-reflow.Data analysis was analyzed by SPSS 21.0 statistical software.Result:1 The characteristics of Clinical dataThere were statistical differences between the no-reflow group and the normal flow group in neutrophil count,lymphocyte count,MPV,MPVLR,Scr,ischemia time,preoperative TIMI0,using those preoperative drugs of anti-platelet or thrombolytic,length of diseased vessels,the proportion ofhigh thrombus burden(TTG ≥ 4)(P < 0.05).There were no significant differences in other clinical data between the two groups(P>0.05).2 The predictive value of MPVLR for no-reflow in coronary arteriesThe predictive value of MPVLR for coronary no-reflow was evaluated by ROC curve.The area under the curve(AUC)was 0.743(95% CI:0.643~0.844).When the cut-point value was 6.45,the Yoden index was the largest(0.41).The sensitivity and specificity of predicting no-reflow respectively 81.5% and 59.2%.3 Grouping according to MPVLR optimal cut-point valuePatients were divided into two groups according to the optimal cut-point value of MPVLR(6.45),high MPVLR group(MPVLR>6.45)and low MPVLR group(MPVLR≤6.45).The difference between the high MPVLR group and the low MPVLR group in the incidence of no-reflow,previous history of myocardial infarction,neutrophil count,lymphocyte count,platelet count,mean platelet volume,ischemia time,preoperative TIMI0,and the proportion of high thrombus burden(TTG ≥ 4)is significant(P<0.05).There were no statistical differences in other characteristics between the two groups(P>0.05).4 Binary logistic regression analysis of coronary no-reflow4.1 Univariate logistic regression analysis: there were associated with the occurrence of no-reflow after pPCI and age,smoking history,neutrophil count,lymphocyte count,MPV,MPVLR,FPG,LVEF,ischemic time,preoperative TIMI 0,preoperative use those drugs of anti-platelet or thrombolytic,high thrombus burden(TTG ≥4)and the differences were statistically significant.4.2 Multivariate logistic regression analysis: after correcting the relevant variables in the univariate analysis,MPVLR was significantly associated with no-reflow(OR=1.175,95% CI=1.056~1.307,P<0.05),which was independent risk factor of no-reflow.In addition,ischemia time(OR=1.294,95% CI=1.042 ~ 1.608,P=0.020)and high thrombus load(TTG ≥ 4)(OR=4.555,95% CI=1.025 ~ 20.238,P=0.046)were also independent risk factors for no-reflow.Conclusion:1 Compared with the normal flow group,the level of MPVLR was higher in the no-reflow group;2 The optimal cut-point value of MPVLR was 6.45,and the sensitivity and specificity of predicting no reflow after pPCI respectively were81.5%;3 The incidence of no-reflow in the high MPVLR group was significantly higher than that in the low MPVLR group;4 MPVLR can be used as a new clinical evaluation index to predict the occurrence of no-reflow after pPCI in patients with acute STEMI.