Anemia and Inflammation in ST-Segment Elevation Myocardial Infarction
Enyuan Zhang1, Zhenyu Li, Jingjin Che
1Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease (Key Lab-TIC) (EZ, JC, XC, GL), Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital, Tianjin Medical University, Tianjin, China; Intensive Care Unit (ZL), The Second Hospital, Tianjin Medical University, Tianjin, China; and Tianjin Medical University (TQ, QT, WZ), Tianjin, China.
Insights
Predicting major adverse cardiovascular events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention is possible. Elevated neutrophil/lymphocyte ratio (NLR) and lower hemoglobin (HgB) levels predict MACEs, especially in patients with preserved left ventricular ejection fraction (LVEF).
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers in Cardiovascular Disease
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely intervention.
- Predicting major adverse cardiovascular events (MACEs) post-primary percutaneous coronary intervention (PCI) is crucial for patient outcomes.
- Identifying reliable predictors can optimize post-PCI management strategies.
Purpose of the Study:
- To identify factors predicting the onset of MACEs in STEMI patients undergoing primary PCI.
- To evaluate the predictive value of hemoglobin (HgB), neutrophil/lymphocyte ratio (NLR), and left ventricular ejection fraction (LVEF) for MACEs.
- To explore the role of these factors in different LVEF subgroups.
Main Methods:
- A cohort of 248 STEMI patients who underwent successful primary PCI were enrolled.
- Patients were followed for one year to monitor MACEs.
- Univariate, multivariate logistic regression, and ROC curve analyses were performed to identify independent predictors.
Main Results:
- 14.5% of patients experienced MACEs within one year.
- Independent predictors of MACEs included lower hemoglobin (HgB), higher neutrophil/lymphocyte ratio (NLR), Global Registry of Acute Coronary Event score, and post-PCI left ventricular ejection fraction (LVEF).
- Higher NLR and lower HgB were significant predictors in patients with preserved LVEF (>48%), while NLR also predicted short-term MACEs.
Conclusions:
- Elevated NLR and decreased HgB levels are independent predictors of 1-year MACEs in STEMI patients post-PCI.
- These predictive values are particularly notable in patients with preserved LVEF (>48%).
- Abnormally high NLR on admission is an important indicator for short-term MACE risk.
Background:
To investigate the factors predicting the onset of major adverse cardiovascular events (MACEs) after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) patients.
Methods:
Two hundred forty-eight STEMI patients (61.4 ± 10.8 years, 186 men) who underwent successful primary percutaneous coronary intervention were enrolled. Patients were followed-up for 1 year. Univariate, multivariate analyses, and receiver operating characteristic curve analysis were performed to determine the factors predicting MACEs.
Results:
There were 36 patients (14.5%) who experienced MACEs in the follow-up period. Multivariate logistic regression analysis demonstrated that hemoglobin (HgB) (odds ratio = 0.972; 95% CI, 0.948-0.998; P = 0.033), neutrophil/lymphocyte ratio (NLR) (odds ratio = 1.511; 95% CI, 1.148-1.987; P = 0.003), Global Registry of Acute Coronary Event score, and postprocedure left ventricular ejection fraction (LVEF) were independent predictors of MACEs. Further subgroup analysis showed higher NLR (> 8.61), Global Registry of Acute Coronary Event score (> 167) and lower HgB (< 131 g/L) all show superior predictive value for patients with relatively higher LVEF (> 48%); moreover, the c-statistic of NLR and HgB both exceed 0.7. However, among patients with lower LVEF (≤ 48%), higher NLR and lower HgB lost the ability for predicting 1 year MACEs independently. In addition, abnormally higher NLR (> 8) could predict 1-month MACEs efficiently.
Conclusions:
In summary, among STEMI patients, elevated NLR, decreased HgB level on admission both predicted 1-year MACEs independently, especially for those with relatively preserved LVEF (> 48%). Besides, abnormally higher NLR on admission should attract their attention for short-term MACEs.
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