Abstract:

Objective This study aims to explore the correlation of neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) with major adverse cardiovascular events (MACEs) acute anterior wall ST The relationship between in-hospital major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute anterior wall ST-segment elevation myocardial infarction (STEMI). Methods This was a retrospective study involving 322 patients diagnosed with acute anterior wall STEMI who underwent their first PCI at the First Affiliated Hospital of Jinzhou Medical University between December 2021 and December 2023. Clinical data were collected, and patients were categorized into MACE and non-MACE groups based on the occurrence of in-hospital MACEs. Furthermore, patients were stratified into subgroups according to the presence of chronic diseases, including hypertension (hypertension and non-hypertension subgroups) and diabetes (diabetes and non- diabetes subgroups). Logistic regression analysis and receiver operating characteristic (ROC) curves were employed to investigate the correlation of NLR, dNLR, MLR, and PLR with the incidence of MACEs among the study subjects. Results Multivariate logistic regression analysis showed that NLR (OR=2.232, 95%CI: 1.233-4.041, P=0.008), dNLR (OR=2.128, 95%CI: 1.398-3.237, P=0.015), and the MLR (OR=1.764, 95%CI: 1.118-2.785, P<0.001) were independent risk factors for in-hospital MACEs following PCI in patients with acute anterior wall STEMI. In contrast, PLR did not demonstrate a significant correlation with MACEs. Subgroup analyses revealed that NLR in the hypertension subgroup, dNLR and MLR in the non-hypertension subgroup, and NLR, dNLR, and MLR in the non-diabetes subgroup were independent risk factors for in-hospital MACEs after PCI in patients with acute anterior STEMI (all P<0.05). However, none of the four indicators showed significant differences in the diabetes subgroup (all P>0.05). The ROC curve indicated that NLR (area under the curve [AUC]=0.781, 95%CI: 0.720-0.843, P<0.001), dNLR (AUC=0.687, 95%CI: 0.622-0.753, P<0.001), MLR (AUC=0.711, 95%CI: 0.641-0.781, P<0.001), and PLR (AUC=0.708, 95%CI: 0.639-0.777, P<0.001) all possessed predictive capabilities for the occurrence of MACEs among the study subjects. Furthermore, the combined predictive capability of these four indicators (AUC=0.831, 95%CI: 0.751-0.863, P<0.001) was superior to that of any individual indicator (all P<0.05). Conclusion NLR, dNLR, and MLR are independent risk factors for in-hospital MACEs following PCI in patients with acute anterior wall STEMI. Furthermore, NLR, dNLR, MLR, and PLR exhibit predictive value for in-hospital MACEs, with their combined predictive capability proving to be even more robust.

Key words: anterior wall myocardial infarction, percutaneous coronary intervention, novel inflammatory markers, major adverse cardiovascular events