中性粒细胞与淋巴细胞比值和血小板平均体积对急性冠脉综合征患者PCI术后近期及远期不良事件的预测价值

目的 探讨中性粒细胞与淋巴细胞比值（NLR）和血小板平均体积（MPV）对急性冠脉综合征（ACS）患者接受介入治疗（PCI）后短期及远期主要不良心血管事件（MACE）的预测价值。方法 选择GRAND研究和GRANDEXTENDED研究中接受PCI治疗的ACS患者2 225例，分别按照NLR和MPV的第75百分位数分为高NLR组（n=557）、低NLR组（n=1 668）和高MPV组（n=577）、低MPV组（n=1 635）。比较不同NLR或MPV水平患者无复流/慢血流、住院期间MACE和术后1年MACE的发生情况。采用多因素logistic回归分析评估不良事件发生的独立影响因素。采用ROC曲线分析NLR和（或）MPV对不良事件的预测价值。结果 高NLR组术中无复流/慢血流、住院期间MACE和术后1年MACE的发生率均高于低NLR组（11.7%vs 5.1%,13.5%vs 8.5%和35.0%vs 10.8%;P<0.05）；高MPV组术中无复流/慢血流、住院期间MACE事件和术后1年MACE的发生率均高于低MPV组（12.1%vs 4.8%,17.3%vs 7.0%和29.6%...

Predictive value of NLR and MPV for short-term and long-term adverse events after PCI in patients with acute coronary syndrome

Objective: To explore the predictive value of neutrophil to lymphocyte ratio (NLR) and mean platelet volume (MPV) for short-term and long-term adverse events in patients with acute coronary syndrome (ACS) and undergoing interventional therapy (PCI). Methods: During the period from May 2017 to April 2019, the GRAND study and GRAND-EXTENDED study screened a total of 2421 ACS patients, excluding 196 ACS patients who did not undergo PCI, and finally analyzed 2225 ACS patients who received PCI treatment. They were divided into groups according to the 75th percentile value of NLR and MPV, respectively, to explore the non-reflow/slow blood flow, MACE events during hospitalization and the occurrence of MACE events in 1 year of patients in the high and low value NLR and MPV groups. Results: Compared with the low NLR group, the incidence of non-reflow/slow blood flow, MACE events during hospitalization and 1-year MACE were significantly higher in the high NLR group (11.7% vs 5.1%, 13.5% vs 8.5% and 35.0% vs 10.8%). The incidence of non-reflow/slow blood flow, MACE events during hospitalization and 1-year MACE in the high MPV group was also significantly higher (12.1% vs 4.8%, 17.3% vs 7.0% and 29.6% vs 12.2%). After adjusting for confounding factors, NLR is still an independent predictor of non-reflow/slow flow (RR=1.04, 95% CI 1.01~1.06) and 1-year MACE events (RR=1.01, 95% CI 1.00~1.07), and MPV is an independent predictor of 1-year MACE events (RR=1.02, 95% CI 1.00~1.05); After the combination of NLR and MPV, the AUC of predicting short-term and long-term adverse events increased significantly (0.701, 0.698 and 0.766, respectively). Conclusion: This study shows that NLR and MPV can be used as predictors of short-term and long-term adverse prognosis in ACS patients, and the combination of NLR and MPV for risk stratification has higher predictive value.