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Role of lymphocyte-to-C-reactive protein ratio in forecasting microvascular obstruction in ST-segment elevation
Jiahua Liu1, Xinjia Du1, Yanfei Ren1
1Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Background:
Current research suggests that microvascular obstruction (MVO) following the first percutaneous coronary intervention (PCI) in myocardial infarction patients is closely related to inflammatory responses. The lymphocyte-to-C-reactive protein (CRP) ratio (LCR), as a novel inflammatory marker, is associated with the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). However, the relationship between LCR and MVO remains unclear. This study aims to investigate the correlation between LCR and MVO in STEMI patients undergoing PCI.
Methods:
This was a single-center retrospective study. We consecutively enrolled STEMI patients who underwent PCI at Xuzhou Medical University Affiliated Hospital, Xuzhou, China, from September 2019 to December 2023. Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) was used to assess infarct size and the presence of MVO.
Results:
A total of 551 patients were included in this study, with 267 (48.5%) experiencing MVO. The median time for CMR imaging-based detection of MVO was 5 days (interquartile range: 4, 6). Univariate regression analysis revealed that age, white blood cell count, neutrophil count, left ventricular ejection fraction (LVEF), peak N-terminal pro-B-type natriuretic peptide (NT-proBNP), peak high-sensitivity troponin T (hs-TnT), LCR, LGE percentage (LGE%), and MVO percentage (MVO%) were significantly associated with MVO (p < 0.05). Multivariate regression analysis identified LCR as an independent predictor of MVO [Odds Ratio = 0.18, 95% Confidence Interval (CI): 0.04-0.75, p = 0.019]. Receiver operating characteristic curve analysis demonstrated that LCR had predictive capability for MVO, with a sensitivity of 80.1% and specificity of 45.4% when the LCR value was 0.091 [area under the curve (AUC): 0.654, 95% CI: 0.609-0.700, p < 0.001]. A new predictive model incorporating LCR improved the prediction of MVO occurrence (AUC = 0.815, p < 0.001), with significant differences in net reclassification improvement (p = 0.004) and integrated discrimination improvement (p = 0.023) between the new and old models.
Conclusion:
A low LCR is an independent risk factor for MVO after PCI in STEMI patients. The predictive model incorporating LCR enhances the ability to predict MVO occurrence in patients with STEMI post-PCI.
Insights
A low lymphocyte-to-C-reactive protein ratio (LCR) is an independent risk factor for microvascular obstruction (MVO) in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). Incorporating LCR into predictive models significantly improves MVO occurrence prediction.
Area of Science:
- Cardiology
- Inflammation research
- Biomarker discovery
Background:
- Microvascular obstruction (MVO) post-PCI in myocardial infarction is linked to inflammation.
- The lymphocyte-to-C-reactive protein ratio (LCR) is a novel inflammatory marker with prognostic value in STEMI.
- The relationship between LCR and MVO requires further investigation.
Purpose of the Study:
- To investigate the correlation between LCR and MVO in STEMI patients undergoing PCI.
- To determine if LCR is an independent predictor of MVO.
- To assess the utility of LCR in a predictive model for MVO.
Main Methods:
- Single-center retrospective study of 551 STEMI patients undergoing PCI.
- Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) used to assess MVO.
- Univariate and multivariate regression analyses, ROC curve analysis, and predictive model development.
Main Results:
- LCR was identified as an independent predictor of MVO (OR=0.18, 95% CI: 0.04-0.75, p=0.019).
- LCR demonstrated predictive capability for MVO (AUC=0.654).
- A predictive model incorporating LCR significantly improved MVO prediction (AUC=0.815).
Conclusions:
- Low LCR is an independent risk factor for MVO in STEMI patients post-PCI.
- The LCR-inclusive predictive model enhances MVO occurrence prediction in STEMI patients.
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