The Study Of Predictive Value Of Platelet-to-lymphocyte Ratio Combined With GRACE Score For Cardiovascular Events In Patients With Non-ST-Acute Coronary Syndrome

Objective:This study aims to explore the correlation between platelet-lymphocyte ratio(PLR)and in-hospital and long-term cardiovascular adverse events in patients with non-ST segment elevation acute coronary syndrome(NSTE-ACS),and to examine whether PLR combined with GRACE risk score can improve the predictive value of GRACE risk score for in-hospital and long-term major adverse cardiovascular events(MACE).Methods:A total of 372 patients admitted to the Department of Cardiology with NSTE-ACS in the Affiliated Hospital of Qingdao University from 2016-07 to 2017-07 were studied,including 225 males and 147 females.Blood samples were collected within 24 hours after admission.According to the platelet count and lymphocyte count,the PLR value was obtained.Based on PLR at admission,the patients were divided into 3 groups: group 1,n=124 with PLR<97.56;group 2,n=124 with 97.56≤PLR≤133.32;group 3,n=124 with PLR>133.32.Baseline clinical data,GRACE score,Gesini score and major cardiovascular adverse events(MACE)between the three groups were compared.According to the presence or absence of in-hospital MACE,there were 36 patients with MACE and 336 patients without MACE.All patients were followed up for 18 months after discharge or until an endpoint occurred.According to the presence or absence of long-term MACE,there were 43 patients with MACE and 329 patients without MACE.The differences in baseline clinical data,PLR and GRACE score between the two groups were compared.The correlation between PLR and in-hospital and long-term MACE were evaluated.ROC curve and DELONG method were used to evaluate the predictive value of PLR combined with GRACE score and GRACE score alone for in-hospital and long-term MACE.Results:(1)Group 3 was significantly higher than group 1 and group 2 in terms of platelet count and GRACE score,and was lower in lymphocyte count than group 1 and group 2.In the occurrence of in-hospital and long-term MACE and acute heart failure,group 3 was significantly higher than group 1 and group 2,and the differences were statistically significant(P<0.001).(2)In the occurrence of in-hospital MACE,compared with the no-MACE group,the age,uric acid,platelet count,PLR,Gensini score,and GRACE score were significantly higher in the MACE group,and the diastolic blood pressure,Ccr,and creatinine were significantly lower.The difference was statistically significant(P<0.01).In the occurrence of long-term MACE,compared with the no-MACE group,the MACE group was higher in age,PLR,GRACE score,and lower in Ccr and LVEF.The difference was statistically significant(P<0.05).(3)PLR was an independent predictor of in-hospital MACE in patients with NSTEACS by multivariate logistic regression analysis,and also an independent risk factor of long-term MACE by multivariate Cox regression analysis.(4)The area under the curve of PLR combined with GRACE score to predict the incidence of in-hospital MACE was 0.828,and the area was 0.793 by using GRACE score alone.The difference between the two areas was statistically significant using the Delong method of MEDCALC(P<0.05).(5)The area under the curve of PLR combined with GRACE score to predict the incidence of long-term MACE was 0.758,and the area was 0.680 by using GRACE score alone.The difference between the two areas was statistically significant using the Delong method of MEDCALC(P<0.05).Conclusion:In NSTE-ACS patients,PLR is an independent predictor of in-hospital and long-term MACE.The predictive value of PLR combined with GRACE score for in-hospital and long-term MACE is greater than the GRACE score alone.