Anemia and Inflammation in ST-Segment Elevation Myocardial Infarction

• Published in: The American journal of the medical sciences 2015-06, Vol.349 (6), p.493-498
• Main Authors: Zhang, Enyuan, MD, Che, Jingjin, MD, Chen, Xin, MD, Li, Guangping, MD, PhD, Li, Zhenyu, MD, Qin, Tiantian, BSc, Tong, Qing, BSc, Zhao, Weiwei, BSc
• Format: Article
• Language: English
• Subjects: Aged; Anemia - blood; Anemia - epidemiology; Anemia - etiology; Clinical Investigation; Female; Follow-Up Studies; Hemoglobin; Hemoglobins - metabolism; Humans; Inflammation - blood; Inflammation - epidemiology; Inflammation - etiology; Internal Medicine; Lymphocyte Count; Major adverse cardiovascular events; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - epidemiology; Myocardial Infarction - surgery; Neutrophil/lymphocyte ratio; Percutaneous Coronary Intervention; Postoperative Complications - blood; Postoperative Complications - epidemiology; Registries; STEMI
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1097/MAJ.0000000000000471

Abstract Background To investigate the factors predicting the onset of major adverse cardiovascular events (MACEs) after primary percutaneous coronary intervention for sT-segment elevation myocardial infarction (STEMI) patients. Methods Two hundred forty-eight STEMI patients (61.4 ± 10.8 years, 186 men) who underwent successful primary percutaneous coronary intervention were enrolled. Patients were followed-up for 1 year. Univariate, multivariate analyses, and receiver operating characteristic curve analysis were performed to determine the factors predicting MACEs. Results There were 36 patients (14.5%) who experienced MACEs in the follow-up period. Multivariate logistic regression analysis demonstrated that hemoglobin (HgB) (odds ratio = 0.972; 95% CI, 0.948-0.998; P = 0.033), neutrophil/ lymphocyte ratio (NLR) (odds ratio = 1.511; 95% CI, 1.148–1.987; P = 0.003), Global Registry of Acute Coronary Event score, and postprocedure left ventricular ejection fraction (LvEF) were independent predictors of MACEs. Further subgroup analysis showed higher NLR (> 8.61), Global Registry of Acute Coronary Event score (> 167) and lower HgB (< 131 g/L) all show superior predictive value for patients with relatively higher LVEF (> 48%); moreover, the c-statistic of NLR and HgB both exceed 0.7. However, among patients with lower LVEF (≤ 48%), higher NLR and lower HgB lost the ability for predicting 1 year MACEs independently. In addition, abnormally higher NLR (> 8) could predict 1-month MACEs efficiently. Conclusions In summary, among STEMI patients, elevated NLR, decreased HgB level on admission both predicted 1-year MACEs independently, especially for those with relatively preserved LVEF (> 48%). Besides, abnormally higher NLR on admission should attract their attention for short-term MACEs.