The clinical value of preoperative lymphocyte to C-reactive protein ratio in predicting slow blood flow/no reflow during percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Liu Yehong; Zong Gangjun

Abstract：Objective Lymphocyte to C-reactive protein ratio(LCR)is a novel immune inflammatory marker for some diseases.This study aimed to explore the correlation between LCR and slow blood flow/no reflow in ST-segment elevation myocardial infarction(STEMI)patients after emergency percutaneous coronary intervention(PCI),and further explore the relationship between preoperative LCR levels and long-term major adverse cardiovascular events in patients with STEMI.Methods A total of 537 STEMI patients who underwent primary PCI in the Department of Cardiology,the 904 th Hospital of Joint Logistic Support Force of People's Liberation Army from February 2016 to December 2018 were consecutively included.According to the TIMI classification of coronary flow after percutaneous transluminal coronary angioplasty(PTCA)or stent implantation,537 patients were divided into the normal flow group(TIMI=3,n=415)and the no reflow group(TIMI<3,n=122).The discharged patients were followed up for a long time.The main adverse cardiovascular events included cardiovascular death,new non fatal myocardial infarction,unstable angina,stent implantation,stent stenosis,malignant arrhythmia and heart failure hospitalization The receiver operating characteristic curve was used to evaluate the predictive value of composite inflammatory markers such as LCR for the risk of slow blood flow/no reflow and long-term adverse cardiovascular events in patients with STEMI.Univariate and multivariate Logistic regression/Cox proportional hazards analysis were used to define independent associated factors.Results In the evaluation of composite inflammatory markers,preoperative LCR showed the highest accuracy in predicting the risk of slow blood flow/no reflow(AUC:0.715).Multivariate logistic regression analysis showed that low preoperative LCR(LCR<0.168)(OR:5.088,95%CI:2.409～10.746,P<0.001)was an independent risk factor for slow blood flow after PCI in STEMI patients.Multivariate Cox analysis showed that slow blood flow/no reflow(HR:1.878,95%CI:1.363～2.588,P<0.001)and low preoperative LCR(LCR<0.168)(HR:1.050,95%CI:1.002～1.009,P<0.001)were independent risk factors for long-term adverse cardiovascular events in STEMI patients after PCI.Conclusion Preoperative LCR is a new and valuable composite inflammatory marker.Low preoperative LCR level is an independent risk factor for the occurrence of slow blood flow/no reflow in STEMI patients undergoing emergency PCI and the occurrence of long-term adverse cardiovascular events.