Preoperative Plus Postoperative Neutrophil-Lymphocyte Ratio Predict The Prognosis Of Elderly Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention

ObjectiveThe purpose of this study is to explore the relationship between preoperative plus postoperative neutrophil-lymphocyte ratio(PP-NLR)and the prognostic of elderly patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).The predictive value of PP-NLR and preoperative NLR,postoperative NLR,Glasgow prognostic score(GPS),Prognostic index(PI)score were evaluated and compared.MethodsClinical data of elderly AMI patients who first underwent PCI in Guangzhou Red Cross Hospital from January 1,2015 to January 31,2019 were retrospectively collected,and 169 patients were selected as the subjects of this study strictly according to inclusion and exclusion criteria.First,the preoperative and postoperative NLR thresholds after optimal truncation values were determined using the Receiver operating characteristic curve(ROC).The assigned value was grouped according to the definition of PP-NLR,and the clinical baseline data were compared between different groups.Logistic and Cox analysis were respectively used to select the risk factors of short-term and long-term prognosis of elderly AMI patients after PCI.Correlation analysis was performed to determine the relationship between each indicator and prognostic outcome.Survival analysis was performed to understand the difference in survival rate between groups.Finally,the predictive value of each indicator was evaluated and compared through the area under the ROC curve.Results1.This is the part of short-term outcomes with major adverse cardiovascular events(MACE)occurring within 1 year:(1)ROC curve analysis showed that when the Youden index was at its maximum,the preoperative NLR and postoperative NLR thresholds were 4.29 and 3.27 respectively.(2)The higher the PP-NLR,the higher the preoperative and postoperative white blood cell count,neutrophil count,NLR and h S-CRP,while the lower the preoperative and postoperative lymphocyte count,These differences were statistically significant(P<0.05).(3)Logistic analysis showed that PP-NLR[1 point:OR=3.520,95%CI(1.376,9.005),P=0.009;2 points:OR=50.258,95%CI(10.758,234.788),P<0.001] and heart rate at admission[OR=1.031,95%CI(1.002,1.061),P=0.038] were independent risk factors for the occurrence of MACE within 1 year after PCI in elderly AMI patients(P<0.05).(4)Correlation analysis showed that PP-NLR,preoperative NLR,postoperative NLR,GPS and PI scores were positively correlated with the occurrence of MACE in elderly AMI patients within 1 year after PCI(P<0.05),with correlation coefficients r being 0.532,0.367,0.385,0.389 and 0.419,respectively.(5)When the optimal truncation value was taken,the sensitivity of PP-NLR to preoperative NLR,postoperative NLR,GPS and PI scores were 0.800,0.550,0.600,0.900 and 0.750,while the specificity were 0.670,0.826,0.835,0.450 and 0.633.The areas under the curve were 0.793,0.721,0.732,0.720 and 0.729.2.This is the part of long-term outcomes with an all-cause death occurring within 3 years:(1)ROC curve analysis showed that when the Youden index was at its maximum value,the preoperative and postoperative NLR thresholds were 2.80 and 3.76 respectively.(2)The higher the PP-NLR,the higher the proportion of Killip grade≥2,Hs-CRP,postoperative white blood cell count,preoperative and postoperative neutrophil count and NLR,while the lower the preoperative and postoperative lymphocyte count and LVEF,These differences were statistically significant(P<0.05).(3)Cox analysis showed that PP-NLR[2 point:HR=17.094,95%CI(4.969,58.800),P<0.001],heart rate at admission[HR=1.036,95%CI(1.012,1.061),P=0.003] and serum creatinine[HR=1.012,95%CI(1.001,1.023),P=0.035] were independent risk factors for the occurrence of all-cause death within 3 years in elderly AMI patients after PCI.(4)Correlation analysis showed that PP-NLR,preoperative NLR,postoperative NLR and GPS were positively correlated with all-cause death in elderly AMI patients within 3years after PCI(P<0.05),with correlation coefficients r of 0.395,0.203,0.315 and 0.159,respectively.(5)Survival analysis showed that there was a statistically significant difference in survival rate between the three groups(P<0.05).There was a significant difference in survival rate between PP-NLR=2 and PP-NLR=0 or 1(P<0.05),and there was no significant difference in survival rate between PP-NLR=0 and PP-NLR=1(P<0.05).(6)When the optimal truncation value was taken,the sensitivity of PP-NLR to preoperative NLR,postoperative NLR,GPS and PI scores were 0.516,0.839,0.581,0.419 and 0.581,while the specificity were 0.928,0.478,0.884,0.775 and 0.514.The areas under the curve were 0.771,0.651,0.735,0.611 and 0.559.Conclusion1.PP-NLR is positively correlated with the AMI patients after PCI occur MACE within 1 year and all-cause death within 3 years,meaning that the higher the value of PP-NLR,the worse the patient’s prognosis may be.2.PP-NLR is an independent influencing factor for MACE within 1 year and all-cause death within 3 years in elderly AMI patients after PCI.3.Comparing with preoperative or postoperative NLR,GPS and PI score,the predictive value of PP-NLR is higher and PP-NLR can quickly and conveniently evaluate the prognosis of elderly AMI patients after PCI with relatively high efficiency.