The Predictive Value Of Modified Shock Index And Monocyte/high-density Lipoprotein Cholesterol In Patients With NSTEMI After PCI

Research background and objective:There are numerous causes of hospitalization and death in cardiovascular diseases worldwide and in China,among which non-ST-segment elevation myocardial infarction is the most important determinant of health economics.Grace score is the most commonly used risk assessment model for it.However,the risk assessment model has many indicators,which increases the workload of clinicians.Heart rate/systolic blood pressure can be expressed by shock index,while Heart rate/mean arterial pressure was measured by modified shock index,both of which can be obtained by simple numerical calculation rather than complicated calculation.In recent years,more and more studies have shown that shock index has a predictive effect on the prognosis of acute myocardial infarction,and some studies have shown that the predictive value of modified shock index is better than that of shock index.The monocyte/HDL cholesterol ratio is one of several novel prognostic indicators of cardiovascular diseases,which is associated with inflammation and oxidative stress.Aimed to explore correct shock index,monocyte/high-density lipoprotein cholesterol ratio for Chinese patients with NSTEMI predict outcome at 6 months after PCI value,thus results through simple numerical comparison,will assess severity patients as soon as possible,as soon as possible inform patients,early intervention,reduce the rate of readmission.Methods:Data for this study were collected from patients who were first diagnosed with NSTEMI and PCI according to diagnostic criteria in Northern Jiangsu People’s Hospital from January 2018 to February 2020.mainly included cardiogenic shock,new heart failure,new malignant arrhythmia,recurrent myocardial infarction,and all-cause death.After the patients was admitted to the hospital,he/her was instructed to sit still and test his heart rate and blood pressure,and modified shock index was calculated.The critical value of modified shock index was 1.4.There are two types in the overall population,that is MSI<1.4 and MSI ≥ 1.4.Taking the mean MHR of 0.59 as the limit.There are two groups in the overall population,that is MHR<0.59 and MSI≥0.59.Contrast the above types of data.According to the follow-up results,the predictive value of MSI and MHR in the occurrence of MACE within 6 months in patients with NSTEMI was analyzed.Results:1.According to the admission criteria and exclusion criteria,the study population was finally determined to be 198 cases,among which the ratio of male patients to female patients was 140:58.2.According to the MSI critical value standard,there were 144 people in the final MSI low value group,including 96 males(66.67%)and 48 females(33.33%),with an average age of 63.99±12.25.There were 54 patients in the MSI high-value group,including 44 males(81.48%)and 10 females(18.52%),with a mean age of67.54±11.83.As we can see that between the MSI groups of patients for male in gender,systolic pressure,diastolic pressure,Killip classification≥2,body mass index,or higher hemoglobin levels,lymphocyte count,red blood cell distribution width,serum creatinine,blood lipid level,ECG ST segment downshift,creatine kinase isoenzyme level,left ventricular ejection fraction and MHR ratio,P values were within the 0.05,the results make sense.In terms of age,past medical history,platelet count,neutrophil count,serum potassium level,white blood cell count,serum uric acid level,liver enzymes,and D-dimer,the P value between the two groups was above 0.05,indicating no difference3.According to the mean MHR of 0.59,there were 113 people in the final low MHR group,including 70 men(61.9%).There were 85 MHR high-value subjects,including 70 males(82.4%).There were significant differences(P < 0.05)between the two MHR groups in gender male,systolic blood pressure,previous smoking history,diabetes history,lymphocyte count,white blood cell count,platelet count,MSI,Killip grade ≥2,while were pointless differences in other aspects(P≥0.05).4.Telephone and outpatient visits were conducted according to patients’ communication methods,and the incidence of MACE events was recorded.The follow-up time was 6 months.The incidence of MACE events between MSI and MHR groups was compared,and the results showed that the incidence of MACE events was significant between the two groups(P < 0.05).According to patients condition,there are two types in the overall population that is event group and incident MACE group.To contrast the data of the two of patients with general and biochemical indexes,the results show that patients in age(P=0.046),body mass index(P=0.019),hemoglobin levels(P=0.002),serum creatinine(P=0.01),MSI(P=0.003),MHR(P=0.001)have statistical make sense,other are P values are not in the 0.05 range,have pointless difference.5.In addition,in order to explore the relationship between MHR and MSI,the scatter diagram was used to analyze and the conclusion was drawn that there was a positive correlation between MHR and MSI.Spearman correlation coefficient r was equal to 0.267,and P was less than 0.001.6.Put the 198 patients as a whole to MACE incidents as dependent variables(MACE incident MACE incident to 1,not 0),with age,BMI,hemoglobin,serum creatinine levels,left ventricular ejection fraction,MSI,MHR and possible risk factors for smoking history,diabetes history as independent variables.MHR,MSI is NSTEMI after PCI independent risk factors of MACE events in months.OR values were 6.507 and 15.011,respectively.7.Make ROC curve--receiver operating curve of MHR and MSI.Calculate the area under the two curves and get MHR is 0.809 and MSI is 0.718.The software Med Calc was used to perform De Long analysis on the ROC curves of the two,and the results showed that P≥0.05,and there was no significant difference between the two.Conclusion:MSI and MHR are risk factors for the prognosis of patients with NSTEMI after PCI,and they have similar predictive value,and MHR has better sensitivity,while MSI has better specificity.