The Prognosis Value Of GLR In Acute Coronary Syndrome Patients

BackgroundAcute Coronary Syndrome(ACS)is the most critical and fatal types of coronary heart disease.With the deepening of research in recent years,people have discovered some new risk factors for cardiovascular disease,including inflammatory factors,metabolic factors and imbalance of oxidative system.These "novel risk factors" are closely associated with the treatment and prognosis of ACS.γ-glutamyltransferase(GGT)is a marker of oxidative stress,which plays an important role in the occurrence and development of coronary heart disease.A large number of experiments have indicated that GGT has an important relationship with CHD and ACS.In ACS patients,serum GGT is an independent predictor of major adverse cardiovascular events(MACE),which had Significantly reduced in patients with lower GGT.There is an inflammatory process in the pathogenesis of ACS.Lymphocytes(LY)are important inflammatory cells in our body.In previous literatures,lymphopenia was associated with poor prognosis in patients with CHD and ACS.In ACS patients,lymphopenia is associated with decreased ejection fraction,extensive myocardial infarction,and increased risk of microvascular occlusion in patients undergoing reperfusion therapy.Both GGT and lymphocytes have been shown to be associated with the prognosis of ACS.The γ-glutamyltransferase to lymphocytes ratio(GLR),which combines the two pathways of inflammatory response and oxidative stress response,should have better predictive value for ACS patients than GGT or LY alone.Currently,only two studies reported that preoperative GLR is an independent predictor of poorer survival in patients with intrahepatic cholangiocarcinoma or nonfunctional pancreatic neuroendocrine tumors after resection.There is no research report on the relationship between GLR and ACS in the world.ObjectiveAssessing the correlation between GLR and ACS and the predictive value of GLR in ACS patients after PCI.MethodsOne thousand two hundred and forty eight patients hospitalized in cardiovascular department in the First Affiliated Hospital of Shantou University School of Medicine from January 2015 to December 2020 were included.The patients’ baseline data,venous blood routine,blood biochemical indexes on admission or next morning and coronary angiography results were collected through the electronic medical records of the inpatient system.Follow-up by telephone and inpatient medical record system in the 1st,3rd,6th,and 12 th months after discharge,and the end point of follow-up was the first MACE within 1 year after diagnosis of acute coronary syndrome.All data were analyzed by IBM SPSS 26.0.A p<0.05 was considered statistically significant.Results1.Using the MACE occurred within one year as the end point,the optimal cut-off values were verified using ROC curve analysis.For all patients in this study,a GLR cut-off value amount to 2.67 provided the highest sensitivity and specificity(55% and74%).2.The ratio of cigarette smoking and drinking history,WBC,NE,PLT,AST,ALT,GGT,GLU,TC,TG,Gensini score with patients in the high GLR group were significantly higher than the low GLR group.However,the LY,LY%(p<0.001)was higher in the low GLR group.3.Compared to the patients in the low GLR group,patients in the high GLR group had higher incidence of readmission,heart failure,malignant arrhythmia and higher total incidence.However,there were no significant differences between the high and low GLR group in the incidence of nonlethal myocardial infarction and death in all result.4.Kaplan-Meier curve analysis showed that the incidence of MACE in the high GLR group within 1 year was significantly higher than that in the low GLR group.5.Using multivariate analyses,the results showed that after adjusting for traditional risk factors,high GLR was still significant prognostic factors for increased the incidence of MACE within one year in patients with ACS.(p<0.001).Conclusion GLR is an independent predictor of MACE occurred within 1 year in acute coronary syndrome patients.