Association Of Platelet-to-lymphocyte Ratio With Periprocedural Myocardial Infarction And Its Predictive Value Among Elderly Patients Undergoing Percutaneous Coronary Intervention For Acute Coronary Syndrome

Objective: To analysis the predictive value of the inflammatory markers on periprocedural myocardial infarction(PMI)in the elderly patients undergoing percutaneous coronary intervention(PCI)for non-ST segment elevation acute coronary syndrome(NSTE-ACS).Methods: This retrospective study enrolled consecutive 206 elderly patients with NSTEACS who undergoing PCI in department of geriatric cardiology of the First Affiliated Hospital of China Medical University between January 2014 and December2017.The clinical data of patients including risk factors,clinical presentation,lipid profiles,inflammatory markers and the level of troponin I(pre-and post-PCI)were collected.The patients were divided into PMI group(n=28)and No-PMI group(n=178) according to the serum level of troponin I.Finally,26 patients and 90 patients were matched by propensity score matching(PSM)to make them comparable and the risk factors and predictors affecting PMI were analyzed.Results: After performing PSM,platelet-to-lymphocyte ratio(PLR)in the PMI group was more likely to be higher than No-PMI [159.43(105.81,196.13)vs 123.86(92.46,149.60),P=0.021].In multivariable analyses,the independent risk factors of PMI were PLR(OR=2.04;95% CI=1.24-3.35,P=0.005)together with the non-ST-segment elevation myocardial infarction(OR=4.69,95%CI=1.30-16.87,P=0.018),stent numbers(OR=2.61,95%CI=1.45-4.69,P=0.001),and decreased HDL-C(OR=0.09,95% CI=0.01-0.72,P=0.024).There was a progressive increase in PMI rates from the lowest to the highest PLR quartile(P for trend=0.013).A PLR>149.92 had a sensitivity of 57.70%and a specificity of 75.60% in predicting PMI(P = 0.021).Subgroup analysis shown that Patients with the PLR>149.92(n=37)receiving intensity statin therapy had a significantly lower incidence of the PMI than those treated with non-intensity statin(11.11% vs50.00%,P=0.039).Conclusion: The independent risk factors of PMI were PLR together with the non-ST-segment elevation myocardial infarction,stent numbers,and decreased HDL-C in elderly patients with NSTE-ACS who underwent PCI.PLR might specifically predict incidence of PMI.And with the elevation of PLR,the rate of PMI increases in those patients.In addition,loading statin therapy in those subjects with higher baseline PLR levels appears to exert a lower risk of PMI.