The Predictive Value For Major Adverse Cardiovascular Events In Patients With STEMI After Primary PCI With Combination Of Neutrophil/lymphocyte And CHA2DS2-VASc Score

Objective:To explore the risk factors of major adverse cardiovascular events(MACE)during hospitalization in patients with acute ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention,and to evaluate the value of neutrophil-to-lymphocyte ratio(NLR)and CHA2DS2-VASc score in predicting MACE in patients with STEMI.The predictive value of NLR and CHA2DS2-VASc score in predicting MACE in patients with STEMI during hospitalization were compared between the combination of the two and single use of NLR.Methods:A total of 1364 patients with acute STEMI were treated with primary PCI in the Department of Cardiology of the First Hospital of Jilin University from August 2018 to August 2019.1110 patients who met the admission criteria were selected.Venous blood samples were taken from all patients and sent for examination immediately,and the relevant clinical data of patients were queried through cases: age,sex,previous medical history,coronary angiography results,and the occurrence of MACE after PCI.NLR was calculated according to the first blood routine.According to the occurrence of MACE in the hospital,the patients were divided into two groups: MACE group and non-MACE group.The clinical data,CHA2DS2-Vasc score,and NLR level were compared between the two groups.The best cutoff points of NLR and CHA2DS2-Vasc scores for predicting the occurrence of MACE in the hospital were calculated according to the receiver operating characteristic curve(ROC).According to the optimal cutoff values of NLR,the patients were divided into two groups: high NLR group and low NLR group.According to the best cutoff value of CHA2DS2-Vasc score,the patients were divided into two groups: high CHA2DS2-Vasc score group and low CHA2DS2-Vasc score group.The incidence of MACE between the two groups was compared.The NLR and CHA2DS2-Vasc scores were divided into high NLR and high CHA2DS2-VASc score,high NLR and low CHA2DS2-VASc score,low NLR and high CAH2DS2-VASc score,and low NLR and low CHA2DS2-VASc score,and the total incidence of MACE among the four groups was observed.Logistic regression analysis was used to find out the risk factors of MACE in patients with STEMI during hospitalization after primary PCI.The predictive value of NLR,CHA2DS2-Vasc score,and their combination in predicting MACE during hospitalization after PCI in STEMI patients was analyzed by ROC.All the data were statistically analyzed by SPSS 22.0.Reselts:1.According to the inclusion and exclusion criteria,1110 patients with STEMI were studied.During the period of hospitalization,169 patients developed MACE,no MACE occurred in 941 patients.Age,diabetes,hypertension,previous myocardial infarction,past stroke,neutrophil count,lymphocyte count,NLR,fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),peak cardiac troponin I,left ventricular ejection fraction(LVEF)in MACE and non-MACE groups.There were significant differences in LVEF,Killip classification,CHA2DS2-VASc score,number of diseased coronary arteries and multi-vessel lesions(P < 0.05).2.According to ROC analysis,NLR predicted the area under the curve(AUC)of MACE in STEMI patients during hospitalization after primary PCI treatment AUC was 0.833(95%CI:0.794-0.872,P < 0.001).When the cut-off value of NLR was5.265,the prediction performance was the best,the sensitivity was 79.9%,and the specificity was 81.5%.After grouping according to the best cut-off value of NLR,it was found that the incidence of MACE in the high NLR group was significantly higher than that in the low NLR group,and the difference was statistically significant.3.According to ROC analysis,CHA2DS2-VASc score predicted the AUC of STEMI patients during hospitalization after primary PCI was 0.768(95%CI:0.730-0.807 P < 0.001),the best cutoff value was 2.50,the sensitivity was67.5%,and the specificity was 77.0%.After grouping according to the best cut-off point of CHA2DS2-VASc,it was found that the incidence of MACE in the high CHA2DS2-Vasc score(≥ 3)group was significantly higher than that in the low CHA2DS2-Vasc score(< 3)group(P < 0.05).4.Logistic regression analysis was used to find out the risk factors of MACE during hospitalization after primary PCI in patients with STEMI.The results showed that previous history of myocardial infarction,high CHA2DS2-VASc score on admission,high neutrophil count,low lymphocyte count,high NLR,high fasting blood glucose and high LDL-C were all risk factors for MACE in patients with STEMI during hospitalization after primary PCI.According to ROC analysis,the AUC of NLR combined with CHA2DS2-VASc score for MACE during hospitalization was 0.865(95%CI:0.829-0.901,P < 0.001),the sensitivity was 82.2%,and the specificity was 85.4%.By comparing AUC,it was found that NLR combined with CHA2DS2-VASc score could further improve the predictive value of MACE during hospitalization in patients with STEMI after primary PCI.5.Compared with the high NLR and high CHA2DS2-VASc score group,the total incidence of MACE in the high NLR and low CHA2DS2-VASc score group,the low NLR high CHA2DS2-VASc score group,and the low NLR and low CHA2DS2-VASc score group was lower,and the difference was statistically significant(P=0.000).Conclusion:1.NLR,CHA2DS2-VASc score,previous history of myocardial infarction,low lymphocyte count,high neutrophil count and LDL-C were risk factors for MACE in patients with STEMI during hospitalization after primary PCI.2.NLR and CHA2DS2-VASc score can be used as predictors of MACE in patients with STEMI during hospitalization after primary PCI,and NLR combined with CHA2DS2-VASc score can further improve the predictive value of MACE in patients with STEMI during hospitalization after primary PCI.