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Prognostic Value of Pre-Infarction Angina Combined with Mean Platelet Volume to Lymphocyte Count Ratio for No-Reflow
Xinsen Chen1, Youbao Meng2, Meng Shao3
1Department of Emergency, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China (mainland).
Insights
Pre-infarction angina (PIA) and high mean platelet volume to lymphocyte count ratio (MPVLR) predict no-reflow phenomenon and mortality in ST-segment elevation myocardial infarction (STEMI) patients. Combining PIA and MPVLR improves prediction accuracy for these adverse outcomes after percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Biomarkers
- Clinical Prediction
Background:
- ST-segment elevation myocardial infarction (STEMI) poses significant risks, including no-reflow phenomenon and short-term mortality.
- Predictive markers for these adverse outcomes are crucial for timely intervention and improved patient management.
Purpose of the Study:
- To evaluate the clinical predictive value of pre-infarction angina (PIA) and mean platelet volume to lymphocyte count ratio (MPVLR) for no-reflow phenomenon and 90-day mortality in STEMI patients undergoing percutaneous coronary intervention (PCI).
- To compare the predictive performance of PIA, MPVLR, and their combination against established scores like the GRACE score.
Main Methods:
- A cohort of 1009 STEMI patients undergoing PCI was analyzed.
- Patients were grouped based on PIA occurrence and MPVLR levels.
- Statistical analysis, including logistic regression and Area Under the Curve (AUC) comparison, was used to identify predictors and assess predictive performance.
Main Results:
- Both MPVLR and PIA were identified as independent predictors of no-reflow phenomenon and 90-day mortality.
- Higher MPVLR and the presence of PIA were associated with increased risk.
- The combination of MPVLR and PIA demonstrated superior performance in predicting no-reflow phenomenon (AUC=0.847) and 90-day mortality (AUC=0.790) compared to individual markers and the GRACE score.
Conclusions:
- High MPVLR and PIA are significant independent predictors of no-reflow phenomenon and 90-day mortality in STEMI patients post-PCI.
- The combined application of MPVLR and PIA offers an effective and improved strategy for predicting these critical adverse events.
Abstract:
BACKGROUND The aim of the present study was to investigate the clinical predictive value of pre-infarction angina (PIA) combined with mean platelet volume to lymphocyte count ratio (MPVLR) for no-reflow phenomenon and short-term mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). MATERIAL AND METHODS A total of 1009 STEMI patients who had undergone PCI were enrolled and subdivided into 4 groups based on the occurrence of PIA and the presence of MPVLR above or below the cutoff value. Analysis of the predictors of the no-reflow phenomenon and 90-day mortality was conducted. Further, evaluation and comparison of the clinical predictive value of PIA, MPVLR, and their combination were done. RESULTS Both MPVLR (odds ratio [OR]=1.476, 95% confidence interval [CI]: 1.401 to 1.756, P<0.001; hazard ratio [HR]=1.430, 95% CI: 1.287 to 1.643, P<0.001) and PIA (OR=0.905, 95% CI: 0.783 to 0.986, P<0.001; HR=0.878, 95% CI: 0.796 to 0.948, P<0.001) were independent predictors of no-reflow phenomenon and 90-day mortality. Spearman's rank correlation test revealed that MPVLR (r=-0.297, P<0.001), monocyte to lymphocyte count ratio (MLR) (r=-0.211, P<0.001) and neutrophil to lymphocyte count ratio (NLR) (r=-0.389, P<0.001) in peripheral blood were significantly negatively correlated with postoperative left ventricular ejection fraction (LVEF). Upon comparing the area under curve (AUC), the MPVLR combined with PIA achieved better performance in differentiating no-reflow phenomenon (AUC=0.847, 95% CI: 0.821 to 0.874) and 90-day mortality (AUC=0.790, 95% CI: 0.725 to 0.855), than the GRACE score, MPVLR and PIA alone, and had similar performance to all other pairwise combinations of the GRACE score, MPVLR and PIA. CONCLUSIONS High MPVLR and PIA were independent predictors of the no-reflow phenomenon and 90-day mortality in patients with STEMI after PCI. Moreover, Combined application of MPVLR and PIA can effectively predict the occurrence of the no-reflow phenomenon and 90-day mortality.
