Exploratory predictive value of novel inflammatory biomarkers for microvascular obstruction after emergency revascularization in STEMI patients

To assess the associations of blood cell-derived inflammatory markers with the formation of microvascular obstruction (MVO) and their exploratory predictive performance in STEMI patients after PCI.

A retrospective analysis was conducted based on a prospective cohort, which included the patients with ST-segment elevation myocardial infarction (STEMI) who underwent emergency percutaneous coronary intervention (PCI) at Nanjing Drum Tower Hospital. All patients underwent cardiac magnetic resonance imaging within 7 days post-surgery, and were classified into MVO and non-MVO groups based on the examination results. Emergency and first post-PCI routine blood test and other clinical data were collected from patients, and various cell ratios were calculated, including the monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI). The risk factors for MVO were evaluated by univariate and multivariate logistic regression analysis.

A total of 311 patients with STEMI were included. Among them, 198 developed MVO and the other 113 were MVO free. After adjustment for clinical covariates, higher post-PCI WBC, NEU, SIRI and NLR and greater peri-PCI eosinophil decline were associated with MVO. In the correlation-reduced joint analysis, post-PCI SIRI retained the most robust association.

Postoperative WBC, NEU, SIRI, NLR, ΔEOS, ΔEOS% showed exploratory predictive performance for the formation of MVO after PCI in STEMI patients, and post-PCI SIRI showed the most robust association after accounting for biomarker intercorrelation.