Preoperative lymphocyte to C-reactive protein ratio: A new prognostic indicator of post-primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Abstract

Background: The lymphocyte-to-C-reactive protein ratio (LCR) is a novel inflammatory biomarker for many diseases. This study aimed to examine the association between LCR and major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention.

Methods: A total of 382 patients with STEMI were included in this study; these patients were enrolled from January 2014 to January 2016 at a single center, and the LCR was calculated for each patient. During the in-hospital and long-term follow-up period, MACEs included cardiovascular death, new-onset non-fatal myocardial infarction, heart failure, malignant arrhythmias, revascularization in unstable angina, and new-onset atrial fibrillation. Using receiver operating characteristic curves, we assessed the predictive impact for MACEs using a combination of six inflammatory markers in patients with STEMI and focused on LCR to elucidate its prognostic value. Univariate and multivariate Cox proportional hazard models were used to define the factors associated with MACEs.

Results: Among the assessed variables, preoperative LCR showed the highest accuracy in predicting hospitalized (AUC:0.71) and long-term follow-up(AUC:0.602) MACEs in patients with STEMI. Decreased preoperative LCR was significantly associated with the Gensini score (P < 0.05) and no-reflow (P < 0.05). Multivariate Cox analysis showed that a high preoperative LCR (cutoff threshold = 112.4) was an independent protective factor for hospitalized MACEs in patients with STEMI (hazard ratio, 0.409; 95 % confidence interval, 0.283-0.590; P < 0.001). A high preoperative LCR (cutoff threshold = 106.3) was an independent protective factor for long-term follow-up MACEs in patients with STEMI (hazard ratio, 0.552; 95 % confidence interval, 0.369-0.740; P < 0.001).

Conclusion: Preoperative LCR is a novel and valuable prognostic marker to determine the occurrence of MACEs in hospitals and long-term follow-up after primary percutaneous coronary intervention in patients with STEMI.

Keywords: Lymphocyte to C-reactive protein ratio; Major adverse cardiovascular events; Percutaneous coronary intervention; Prognosis; ST-segment elevation myocardial infarction.