Correlation Analysis Of Neutrophil To Lymphocyte Ratio (NLR) With Severity Of Coronary Artery Stenosis And In-hospital Major Adverse Cardiovascular Events In Patients With Acute Myocardial Infarction At Early Admission

Objective:To investigate the association of neutrophil to lymphocyte ratio with in-hospital major adverse cardiovascular events and the coronary artery stenosis degree in patients with acute myocardial infarction at the early admission.Methods:We collected 299 AMI patients who were admitted to the heart center from January 2019 to January 2022 by the First Affiliated Hospital of Xinjiang Medical University and underwent Percutaneous Coronary Intervention for the first time.We recorded their general clinical data,laboratory indicators,coronary angiography results,and the incidence of hospital MACE events.We divided them into MACE group(n=102 cases)and non-MACE group(n=197 cases)according to the incidence of MACE during hospitalization.According to the third quantile method of Gensini score,they were divided into low-risk group(≤40 points,n=108 cases),middle-risk group(40-68 points,n=94 cases)and high-risk group(>68 points,n=97 cases).Finally,according to whether the ST segment of the admission ECG is elevated,they were divided into ST segment elevation myocardial infarction(STEMI)group(n=177 cases)and non-ST segment elevation myocardial infarction(NSTEMI)group(n=122 cases).The applied statistical methods mainly include?~2 test,non-parametric Mann Whitney U test,Kruskal Wallish H test,Logistic regression analysis,Subject work curve and Spearman correlation analysis.Results:In the grouping based on in hospital MACE,the NLR[4.59(2.65,7.81)vs 3.39(2.19,5.64),P=0.012]in the MACE group was significantly higher than that in the non-MACE group,with a statistically significant difference.In the grouping based on the Gensini score tertile method,the NLR[3.05(2.23,5.22)vs 3.47(2.32,6.35)vs 4.55(2.92,7.48),P=0.009]of the low Gensini group,the middle Gensini group and the high Gensini group were statistically significant.In the grouping based on the admission ECG changes,the NLR[4.84(2.70,7.85)vs 3.01(2.03,4.54),P<0.001]of STEMI group was significantly higher than that of NSTEMI group,and the difference was also statistically significant.Logistic regression analysis showed that NLR was an independent risk factor for in-hospital MACE(OR=1.064,95%CI 1.002-1.129,P=0.042)and high Gensini score(OR=1.057,95%CI 1.007-1.110,P=0.024)in patients with AMI.The Receiver operating characteristic curve(ROC)results showed that the cut-off value of NLR for predicting the occurrence of MACE in the hospital was 4.545,the sensitivity was 52.00%,the specificity was 65.00%,and the Area Under the Curve(AUC)was 0.589(95%CI0.520～0.657,P=0.012);The cut-off value of high Gensini score(>68)predicted by NLR was 2.850,the sensitivity was 79.4%,the specificity was 42.60%,and the AUC was0.602(95%CI 0.533～0.672,P=0.004).Spearman correlation analysis showed that NLR was positively correlated with CK-MB in both STEMI and NSTEMI groups(r=0.185,P=0.015;r=0.438,P<0.001).Conclusions:High NLR at early admission is an independent risk factor for AMI patients to develop in hospital MACE and high Gensini score(>68 points);NLR at admission is positively correlated with Creatine Kinase Isoenzyme(CK-MB)in both STEMI and NSTEMI patients.NLR is a simple and effective inflammatory indicator,which can be widely used to identify cardiovascular high-risk patients early and guide individualized treatment to improve the prognosis of AMI patients.