Relevance Of Monocyte To HDL Ratio To Angiographic Slow Flow Or No Reflow In Patients With ST-elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention And Its Impact On Short-term Prognosis

ObjectiveIt has been found that the inflammatory reaction is closely related to the occurrence of slow flow or no reflow in patients with acute ST segment elevation myocardial infarction(STEMI).Monocyte to high density lipoprotein ratio(MHR)is a new inflammatory factor that has received more and more attention.The objective of this study was to investigate the relationship between MHR and slow flow or no reflow in patients with STEMI and its short term prognosis.It also discussed the significance of inflammatory factors such as monocyte chemotaxis protein-1(MCP-1)and interleukin-18(IL-18)for patients with STEMI.MethodsIn this study,we selected 216 cases(180 males and 36 females)with STEMI who had undergone percutaneous coronary intervention(PCI)in the Vasculocardiology Department of our hospital from October 2014 to May 2016.There were 43 patients with slow flow or no reflow(the slow flow or no reflow group)and 173 patients with normal flow(the normal flow group).Besides,20 normal cases of matched gender and age were selected to form the control group.After admission,research subjects took tests of blood,liver and kidney function,blood glucose,blood lipids,myocardial enzymes,MCP-1,IL-18,etc.Receiver operating characteristic curve(ROC)analysis was used to analyze the prediction of MHR on slow flow or no reflow.Multivariate logistic regression was used to assess the relevance of MHR to slow flow or no reflow and investigate the incidence of major adverse cardiovascular events(MACE)on a short-term basis in the normal flow group and in the slow flow or no reflow group.Results1、The incidence of slow flow or no reflow after primary PCI in patients with STEMI was 19.9%.2、Compared with the control group(n=20),MHR、MCP-1、and IL18 were significantly increased in the slow flow or no reflow group(n=43).Compared with the control group(n=20),MHR、MCP-1、IL18 were significantly increased in the normal reflow group(n=173).Compared with the normal reflow group(n=173),MHR(18.6±9.8VS10.9±5.5,P<0.001)、MCP-1(198.3±23.3VS168.3±19.1,P<0.05)and IL18(336.6±34.3 VS 278.6±29.8,P<0.05)were significantly increased in the slow flow or no reflow group。3、Univariate regression analysis indicated that high MHR was the risk factor of slow flow or no reflow in STEMI patients(OR 2.22,95%CI 1.58-3.28 P<0.001),Multivariate regression analysis showed that high MHR was the independent risk factor of slow flow or no reflow in STEMI patients(OR=1.55,95%CI 1.01-2.38,P=0.04),Meanwhile,the sensitivity of prediction of MHR>13.37 to slow flow or no reflow is 67.4% and specificity is 70.5%.area under curve is 0.734,(95%CI:0.646-0.822).4.Compared with the normal reflow group,the incidence of the short-term MACE of slow flow or no reflow group was increased by 3 times.Conclusion1.MHR was an independent risk factor for coronary artery slow flow or no reflow after PCI in patients with AMI.When MHR was more than 13.37 in patients with STEMI,the risk of slow blood flow or no reflow after direct PCI was significantly increased.2.Compared with the normal flow group,MCP-1 and IL-18 in slow flow or no reflow group were significantly higher,suggesting that more intense inflammatory response occurred in this group.Both MCP-1 and IL-18 have played a role in predicting whether there would be slow flow or no reflow in patients with AMI who had undergone direct PCI.