Predictive Value Of Platelet-to-lymphocyte Ratio Combined With GRACE Score For The Prognosis In Patients With Acute Coronary Syndrome

Objective:To discuss the association between platelet-to-lymphocyte ratio and global registry of acute coronary events(GRACE)score in Acute Coronary Syndrome(ACS).To explore the clinical predictive value of platelet-to-lymphocyte ratio combined with GRACE score for the incidence of major adverse cardiovascular events(MACE)in patiens with ACS.Methods:A total of 302 patients dignosed with ACS were enrolled in the cardiology department at our hospital between January 2014 and May 2015.According to the GRACE score,which were used for risk stratification and assesment,patients were divided into three groups:131 low-risk group,99 middle-risk group and 72 high-risk group.PLR was calculated from platelet and lymphocyte counts in complete count,According to PLR level,patients were stratified into three groups by tertiles,including low PLR group,middle PLR group and high PLR group.All patients were followed up one year after discharge and observed the incidence of major adverse cardiovascular events(MACE),and classified into MACE group and non-MACE group according to the presence of MACE.To explore the relationship between PLR and GRACE score and the predictive value of PLR combined with GRACE score for MACE in ACS.Results:PLR level in high-risk group was significantly higher than low-risk and middle-risk group(P<0.05),compared with low-risk group,PLR level in middle-risk group was higher(P=0.074),but the differnce was not statistically significant.GRACE score were increased with the elevation of PLR level.PLR leval was positively associated with GRACE score in ACS with Spearman's correlation(r=0.314,P<0.001).There were totally 30 cases of MACE(10.03%)during follow-up.The level of PLR and GRACE score were significantly higher in MACE group than that in non-MACE group(P<0.001).Receive operating characteristic curve(ROC)analysis showed that:the area under curve(AUC)of PLR level was 0.697(SE=0.0514,95%CI:0.642-0.749,P<0.001),the AUC of GRACE score was 0.712(SE=0.0564,95%CI:0.657-0.763,P<0.001)when the GRACE score was caculated alone,but it rose to 0.745(SE=0.0524,95%CI:0.692-0.793,P<0.001)when PLR was added.The differnce between two ROC areas was statistically significant.When PLR level(cut-off point was 130.3,sensitivity was 76.67%,specificity was 62.45%),GRACE score(cut-off point was 128,sensitivity was 63.33%,specificity was 77.70%)and the combination of PLR and GRACE score(cut-off point was 0.07638,sensitivity was 80%,specificity was 62.08%)reached the best cut-off point,their predictive ability achieved the optimal for the incidence of MACE.Conclusion:PLR has a positive correlation between GRACE score in patiens with ACS.PLR,GRACE score and the joint of PLR and GRACE score are the predictors for the occurance of MACE after a period of one year of follow-up.And a combination of PLR and GRACE score is more effective in predicting MACE in ACS.