Prediction Of Long-term Prognosis Based On Neutrophil-lymphocyte Ratio In Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention

Objective:1.Analysis of the relationship between NLR and MACE events in patients with coronary heart disease after PCI,futher,investigate the prognostic value of NLR in patients with ACS and its prognostic value;2.Assess the associations of NLR,high-sensitivity cardiac troponin I(hs-c Tn I)or B type natriuretic peptide(BNP)with the occurrence of major adverse cardiovascular events(MACE)after PCI.Methods:The current study was a retrospective investigation of 276 consecutive patients who underwent assessment of pre-PCI NLR,peak hs-c Tn I and BNP undergoing PCI because of acute coronary syndrome between January 2014 and April 2015 at the second hospital of shanxi medical university.NLR was calculated as the ratio of neutrophil and lymphocyte counts obtained at the time of admission.All patients are given lifestyle and drugs intervention after PCI in order to secondary prevention.The primary end point was MACE,including all causes death,non-fatal myocardial infarction and revascularization of target vessels.The date were obtained by reviewing outpatient documentation or by telephone interviews,and timing of cardiac death was confirmed by review of the electronic medical records.Receiver-operating characteristic(ROC)analysis was carried out to establish the sensitivity and specificity with 95% CIs for the cutoff value of NLR.The freedom from MACE according to the cutoff value of NLR was estimated using the Kaplan-Meier method,and results were compared using the log-rank test.Independent predictors of MACE were calculated by means of Cox proportional hazards regression.Baseline clinical and biochemical factors with a P <0.05 were then entered into a forward stepwise multivariate Cox proportional hazards model.According to hs-c Tn I ?2 times normal value(?0.1ng/ml)and BNP(?100pg/ml)analysis of layers,respectively in hs-c Tn I positive and negative pressure resistance and BNP in normal and elevated subgroup,the relationship between NLR and MACE,using log-rank method and the difference between the groups,and the predictive value of NLR combined with BNP or hs-c Tn I on the long-term adverse events.Results:1.The median follow-up time was 29.2 months,a total of 49 patients had MACE events,of which,there were 17 cases of all-cause death,revascularization of target blood vessels in 25 cases,and non fatal myocardial infarction in 7 cases.The sensitivity and specificity at the NLR cutoff level of 2.94 using the ROC curve were 55.1% and73.7%,the area under the ROC was 0.626(95% CI: 0.532-0.719,P=0.003).The patients were stratified into 2 groups in accordance with the cutoff value of NLR ?2.94(89patients)and <2.94(187 patients).2.The Kaplan-Meier event-free survival curves according to the cutoff value of NLR showing the MACE rates increased significantly in the higher NLR group(30.3% versus11.8%,log-rank: P=0.013).Univariate analysis indicated that age,smoking,NLR ?2.94,peak hs-c Tn T?0.1 ng/ml,peak BNP ?100 pg/ml,high Gensini score were significantly associated with cardiac death.The Cox proportional hazards model included the significant univariate variables.3.The patients were separated into 2 subgroups—myocardial damage or HF,according to peak hs-c Tn T?0.1 ng/ml or BNP ?100 pg/m L levels,respectively,and subgroup analysis was carried out to identify differences between the groups in thepredictive value for MACE at the NLR cutoff level.The survival curve analysis showed a good prediction for cardiac death at the NLR cutoff value in both the myocardial damage and HF subgroups(23.17%vs4.12%,log-rank :P=0.016 19.10%vs5.35%,log-rank:P=0.039).Conclusion:1.Although the patients with ACS after PCI with drug therapy in the two grade prevention standard,but follow-up of 2 years(median time 29.2 months),the MACE event rate is up to 17.75%,suggests that the combination of control risk factors,to find effective treatment strategies for anti-inflammatory has important significance to improve long-term prognosis.2.The elevation of serum NLR in the prediction of ACS after PCI in patients with long-term prognosis has certain diagnostic value in diagnosis,the optimal cut-off was2.94,the events of MACE diagnostic sensitivity was 0.551,specificity was 0.737.The higher level of NLR,the more obvious the inflammation of coronary artery plaque,the higher the incidence of MACE events,and NLR can be used as an independent predictor of long-term MACE events in patients with ACS after PCI.3.The changes of serum hs-c Tn I and BNP levels have predictive value in judging the prognosis of ACS positive patients after PCI,increase the level of MACE significantly increased the incidence of myocardial injury,the more serious,the worse of heart function,the prognosis is poor.4.The NLR combined with hs-c Tn I or BNP can better predict the long-term prognosis of patients with ACS after PCI.