Comparison of Different Systemic Inflammatory Markers in Predicting Clinical Outcomes with Syntax Score in Patients with Non-ST Segment Elevation Myocardial Infarction: A Retrospective Study

Figures & data

Figure 1 Study flow chart.

Table 1 Baseline Demographic and Clinical Characteristics Between Patients with High Syntax Score and Patients with Low Syntax Score

	Patients with High Syntax Score (n = 205)	Patients with Low Syntax Score (n = 224)	p-value
Age, years	61.0 [56.0–68.0]	57.7 [51.0–66.0]	0.000
Sex, male %	154 (75.1)	167 (74.6)	0.912
BMI, kg/m^2	25.1 [23.1–27.3]	24.8 [22.7–26.6]	0.327
Stroke, %	24 (11.7)	28 (12.5)	0.883
Diabetes, %	117 (57.1)	63 (28.1)	0.000
Dyslipidemia, %	106 (51.7)	101 (45.1)	0.177
Prior myocardial infarction, %	24 (11.7)	29 (12.9)	0.770
Prior history of CAD, %	42 (20.5)	41 (18.3)	0.625
Hypertension, %	91 (44.4)	98 (44.1)	1.000
Smoking, %	114 (55.6)	105 (46.9)	0.082
Alcoholic, %	39 (19.0)	30 (13.4)	0.117
Heart rate on admission, bpm	74.6 [68.0–80.5]	71.7 [64.0–78.0]	0.001
Systolic blood pressure on admission, mmHg	136.1 [127.0–144.0]	135.1[125.3–145.0]	0.461
Diastolic blood pressure on admission, mmHg	77.5 [68.0–86.0]	78.8 [69.3–86.8]	0.210
GRACE score	139.8 [127.0–150.5]	137.4 [128.3–147.0]	0.208
Medication before hospitalization, %
Antiplatelet therapy	138 (67.3)	143 (63.8)	0.477
β-blocker	53 (25.9)	74 (33.0)	0.113
Statin	69 (33.7)	92 (41.1)	0.134
ACE-inhibitors/ARB	86 (42.0)	75 (33.5)	0.073
Calcium channel blocker	67 (32.7)	63 (28.1)	0.344

Abbreviations: Syntax, Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery; BMI, body mass index; CAD, coronary artery disease; GRACE, Global Registry of Acute Coronary Events; ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker.

Table 2 Angiographic Characteristics Between Patients with High Syntax Score and Patients with Low Syntax Score

	Patients with High Syntax Score (n = 205)	Patients with Low Syntax Score (n = 224)	p-value
Left main lesion	13 (6.3%)	3 (1.3%)	0.009
Chronic total occlusion lesion	25 (12.2%)	12 (5.4%)	0.015
Bifurcation lesion	19 (7.8%)	19 (8.5%)	0.861
Calcification lesion	12 (5.9%)	8 (3.6%)	0.360
Thrombosis lesion	33 (16.1%)	33 (14.7%)	0.789
Syntax score	27.5 [25.0–30.0]	16.9 [15.0–19.0]	0.000
SVD	60 (29.3%)	131 (58.5%)
MVD	145 (70.7%)	93 (42.6%)	0.000

Abbreviations: Syntax, Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery; SVD, single-vessel disease; MVD, multi-vessel disease.

Table 3 Laboratory Test Results Between Patients with High Syntax Score and Patients with Low Syntax Score

	Patients with High Syntax Score (n = 205)	Patients with Low Syntax Score (n = 224)	p-value
BNP on admission, pg/mL	484.9 ± 158.5	459.8 ± 128.9	0.074
White blood cell count, 10^9/L	9.7 [8.7–10.9]	9.1 [7.8–10.2]	0.000
NLR	6.0 [3.6–7.2]	4.1 [2.7–5.0]	0.000
Red blood cell count, 10^12/L	4.5 [4.1–4.8]	4.5 [4.1–4.9]	0.691
Hemoglobin, g/L	140.1 [133.0–148.0]	143.6 [132.0–153.0]	0.062
Red blood cell distribution width, fpl	29.4 [13.5–40.6]	26.5 [13.0–40.7]	0.083
Platelet count, 10^9/L	226.2 [178.0–258.5]	209.0 [168.3–244.0]	0.001
PLR	179.1 [122.3–209.8]	133.9 [90.6–166.3]	0.000
SII	2.84[1.36–3.40]	1.90[1.01–2.39]	0.000
AST	67.2 [56.0–79.0]	64.8 [54.0–77.0]	0.168
Albumin, g/L	40.7 ± 4.1	43.9 ± 3.7	0.000
HsCRP, mg/L	24.4 [19.7–28.2]	23.3 [18.0–27.5]	0.011
hsCAR	0.6 [0.5–0.7]	0.5 [0.4–0.6]	0.000
eGFR, mL/min	88.6 [76.0–97.0]	85.9 [74.9–95.0]	0.508
Uric acid, mmol/L	369.0 ± 106.5	359.5 ± 91.1	0.324
Glucose, mmol/L	7.5 [5.7–9.0]	7.0 [5.3–8.3]	0.018
HbA1C	6.8 [6.0–7.6]	6.6 [5.8–7.2]	0.031
Total cholesterol, mmol/L	4.7 ± 1.0	4.5 ± 1.2	0.138
Triglyceride, mmol/L	1.8 [1.4–2.0]	1.7 [1.4–1.9]	0.015
HDL-cholesterol, mmol/L	1.1 [0.9–1.3]	1.1 [0.9–1.2]	0.161
LDL-cholesterol, mmol/L	3.0 [2.4–3.5]	2.9 [2.0–3.6]	0.093
Left ventricular ejection fraction on admission, %	51.8 [47.0–57.0]	52.4 [48.0–56.0]	0.267
Peak troponin I during hospitalization, ng/mL	26.1 [7.7–40.1]	24.7 [5.8–35.8]	0.163

Abbreviations: Syntax, Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery; BNP, brain natriuretic peptide; NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio; AST, aspartate transaminase; hsCAR, high-sensitivity C-reactive protein (hsCRP)-albumin ratio; eGFR, estimated glomerular filtration rate; HbA1C, glycosylated hemoglobin 1C; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Table 4 Baseline Demographic and Clinical Characteristics Between Patients with and without MACE

	Patients with MACE (n = 90)	Patients without MACE (n = 339)	p-value
Age, years	57.9 [50.5–67.0]	59.6 [53.0–67.0]	0.253
Sex, male, %	71 (78.9)	250 (73.7)	0.342
BMI, kg/m^2	24.8 [22.3–27.6]	25.0 [23.1–26.8]	0.929
Stroke, %	11 (12.2)	41 (12.1)	1.000
Diabetes, %	31 (34.4)	149 (44.0)	0.119
Dyslipidemia, %	50 (55.6)	157 (46.3)	0.125
Prior myocardial infarction, %	9 (10.0)	44 (13.0)	0.589
Prior history of CAD, %	15 (16.7)	27 (8.0)	0.026
Hypertension, %	41 (45.6)	148 (43.9)	0.812
Smoking, %	57 (63.3)	162 (47.8)	0.009
Alcoholic, %	10 (19.0)	59 (13.4)	0.196
Heart rate on admission, bpm	73.2 [66.0–82.0]	73.0 [66.0–79.0]	0.868
Systolic blood pressure on admission, mmHg	133.1 [122.5–140.3]	136.3 [127.0–145.0]	0.042
Diastolic blood pressure on admission, mmHg	77.7 [69.0–86.3]	78.3 [69.0–86.0]	0.675
GRACE score	139.3 [127.0–147.0]	138.3 [128.0–148.0]	0.702
Medication before hospitalization, %
Antiplatelet therapy	63 (70.0)	218 (64.3)	0.383
β-blocker	27 (30.0)	100 (29.5)	1.000
Statin	28 (31.3)	133 (39.2)	0.179
ACE-inhibitors/ARB	34 (37.8)	127 (37.5)	1.000
Calcium channel blocker	22 (24.4)	108 (31.9)	0.198
Treatment during hospitalization, %
Antiplatelet therapy	89 (98.9)	337 (99.4)	0.507
β-blocker	77 (85.6)	297 (87.6)	0.597
Statin	86 (95.6)	306 (90.3)	0.140
ACE-inhibitors/ARB	63 (70.0)	220 (64.9)	0.384
Calcium channel blocker	27 (30.0)	126 (37.2)	0.218
Percutaneous coronary intervention, %
Drug-eluting stent	82 (91.1)	318 (93.8)
Drug-coated balloon	4 (4.4)	16 (4.7)
Plain balloon	4 (4.4)	5 (1.5)	0.341
Intra-aortic balloon counterpulsation	3 (3.3)	19 (5.6)	0.590
Temporary pacemaker	3 (3.3)	7 (2.1)	0.444
Thrombus aspiration	1 (1.1)	8 (2.4)	0.692
Rotational atherectomy	3 (3.3)	7 (2.1)	0.444

Abbreviations: CAD, coronary artery disease; GRACE, global registry of acute coronary events; ACE, angiotensin-converting enzyme; ARB, Angiotensin-II receptor antagonists.

Table 5 Laboratory Test Results Between Patients with and without MACE

	Patients with MACE (n = 90)	Patients without MACE (n = 339)	p-value
BNP on admission, pg/mL	516.3 ± 157.1	460.0 ± 138.4	0.002
White blood cell count, 10^9/L	10.1 [8.3–10.3]	9.2 [7.9–10.3]	0.000
NLR	6.2 [3.7–7.6]	4.7 [2.9–5.6]	0.000
Red blood cell count, 10^12/L	4.4 [4.1–4.8]	4.5 [4.1–4.9]	0.131
Hemoglobin, g/L	141.7 [133.0–149.0]	142.2 [132.0–151.0]	0.554
Red blood cell distribution width, fpl	28.9 [13.2–40.6]	27.6 [13.2–40.7]	0.863
Platelet count, 10^9/L	220.4 [173.0–250.1]	216.4 [172.0–253.0]	0.751
PLR	180.6 [124.2–210.5]	148.8 [97.5–185.7]	0.007
SII	3.0 [1.2–4.2]	2.2 [1.2–2.8]	0.008
AST	66.6 [56.0–79.2]	65.8 [55.0–77.0]	0.778
Albumin, g/L	42.2 ± 4.0	42.4 ± 4.2	0.592
High-sensitivity C-reactive protein, mg/L	27.6 [21.1–31.3]	22.8 [18.3–26.9]	0.000
hsCAR	0.7 [0.5–0.8]	0.5 [0.4–0.6]	0.000
eGFR, mL/min	85.7 [76.8–94.3]	86.4 [75.0–96.0]	0.734
Uric acid, mmol/L	375.7± 91.5	361.0 ± 100.5	0.115
Glucose, mmol/L	7.1 [5.3–8.4]	7.3 [5.4–8.8]	0.629
HbA1C	6.8 [5.8–7.3]	6.6 [5.9–7.4]	0.896
Total cholesterol, mmol/L	4.6 ± 1.2	4.6 ± 1.1	0.833
Triglyceride, mmol/L	1.8 [1.4–2.0]	1.7 [1.4–2.0]	0.707
HDL cholesterol, mmol/L	1.1 [0.9–1.3]	1.1 [0.9–1.2]	0.553
LDL cholesterol, mmol/L	2.9 [2.1–3.6]	2.9 [2.2–3.5]	0.868
Left ventricular ejection fraction on admission, %	50.1 [45.0–55.0]	52.7 [48.0–57.0]	0.001
Peak troponin I during hospitalization, ng/mL	30.2 [11.0–44.8]	24.1 [5.9–35.4]	0.008
Syntax score	22 [15–33]	21 [17–26]	0.083

Abbreviations: BNP, brain natriuretic peptide; NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio; SII, systemic inflammation index; AST, aspartate transaminase; hsCAR, high-sensitivity C-reactive protein (hsCRP)–albumin ratio; eGFR, estimated glomerular filtration rate; HbA1C, glycosylated hemoglobin 1C; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Table 6 Correlation Between Syntax Score with Different Systemic Inflammation Indicators

	Syntax Score
	r	p
NLR	0.221	0.000
PLR	0.211	0.000
HbA1C	0.041	0.396
hsCAR	0.172	0.000
SII	0.182	0.000
Glucose	0.139	0.004
Platelets	0.107	0.027
Triglyceride	0.152	0.002
hsCRP	0.085	0.079
Albumin	−0.325	0.000

Abbreviations: NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio; HbA1C, glycosylated hemoglobin 1C; hsCAR, high-sensitivity C-reactive protein (hsCRP)–albumin ratio; SII, systemic inflammation index.

Table 7 Univariable and Multivariable Logistic Regression Results for NLR, PLR, hsCAR, SII in Predicting Coronary Artery Severity

	Univariable Analysis			Multivariable Analysis
	OR	95% CI	p value	OR	95% CI	p-value
Diabetes	3.398	2.274–5.077	0.000
Heart rate on admission	1.035	1.013–1.057	0.001
Age, years	1.034	1.014–1.054	0.001
White blood cell count	1.246	1.111–1.397	0.000
NLR	1.315	1.200–1.440	0.000	1.279	1.158–1.412	0.000
Platelet count	1.006	1.002–1.009	0.002
PLR	1.009	1.005–1.012	0.000	1.009	1.006–1.013	0.000
HbA1C	1.136	0.966–1.337	0.124
Glucose	1.018	1.016–1.208	0.020
Triglyceride	1.677	1.152–2.440	0.007
hsCRP	1.017	0.992–1.042	0.188
Albumin	0.812	0.769–0.858	0.000
hsCAR	7.958	2.583–24.517	0.000	8.738	2.649–28.824	0.000

Abbreviations: NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio; HbA1C, glycosylated hemoglobin 1C; hsCAR, high-sensitivity C-reactive protein–albumin ratio; SII, systemic inflammation index.

Table 8 Univariable and Multivariable Logistic Regression Results for NLR, PLR, hsCAR, SII and Syntax Score in Predicting MACE

	Univariable Analysis			Multivariable Analysis
	OR	95% CI	p value	OR	95% CI	p-value
Prior history of CAD	2.311	1.171–4.560	0.016
Smoking	1.887	1.169–3.046	0.009
BNP on admission, pg/mL	1.003	1.001–1.004	0.001
White blood cell count, 10^9/L	1.309	1.144–1.499	0.000
NLR	1.151	1.069–1.238	0.000	1.139	1.050–1.235	0.002
PLR	1.004	1.001–1.007	0.002	1.005	1.002–1.008	0.001
SII	1.248	1.109–1.403	0.000	1.236	1.080–1.415	0.002
HsCRP, mg/L	1.080	1.042–1.119	0.000
hsCAR	15.700	4.229–58.29	0.000	18.464	4.53–75.254	0.000
Syntax score	1.028	0.992–1.065	0.126	1.008	0.970–1.048	0.686
LVEF, %	0.936	0.900–0.974	0.001
Peak troponin I during hospitalization, ng/mL	1.010	1.001–1.019	0.034

Abbreviations: CAD, coronary artery disease; BNP, brain natriuretic peptide; NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio; SII, systemic inflammation index; hsCAR, high-sensitivity C-reactive protein–albumin ratio; LVEF, left ventricular ejection fraction on admission.

Table 9 Comparison of Area Under Curve Between NLR, PLR, hsCAR, SII and Syntax Score in Predicting MACE in 6-Month Follow-Up

Variable	AUC	SE	95% CI	p-value
NLR	0.637	0.0339	0.590–0.683	0.0778^a
PLR	0.592	0.0337	0.544–0.639	0.0326^b
hsCAR	0.631	0.0348	0.584–0.677	0.0721^c
SII	0.590	0.0367	0.542–0.637	0.0312^d
Syntax score	0.559	0.0338	0.511–0.607

Notes: ^aComparison between NLR and Syntax score. ^bComparison between PLR and Syntax score. ^cComparison between hsCAR and Syntax score. ^dComparison between SII and Syntax score.

Abbreviations: AUC, area under curve; SE, standard error; CI, confidence interval; NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio; hsCAR, high-sensitivity C-reactive protein–albumin ratio; SII, systemic inflammation index.

Table 10 Comparison of Area Under Curve Between NLR, PLR, hsCAR, SII and Syntax Score in Predicting Overall Mortality in 6-Month Follow-Up

Variable	AUC	SE	95% CI	p-value
NLR	0.530	0.102	0.324–0.725	0.0897^a
PLR	0.524	0.108	0.476–0.573	0.0951^b
hsCAR	0.761	0.0941	0.718–0.801	0.0662^c
SII	0.553	0.106	0.504–0.601	0.0667^d
Syntax score	0.620	0.0635	0.572–0.666

Notes: ^aComparison between NLR and Syntax score. ^bComparison between PLR and Syntax score. ^cComparison between hsCAR and Syntax score. ^dComparison between SII and Syntax score.

Abbreviations: AUC, area under curve; SE, standard error; CI, confidence interval; NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio; hsCAR, high-sensitivity C-reactive protein–albumin ratio; SII, systemic inflammation index.

Figure 2 Comparison of area under curve between NLR, PLR, hsCAR, SII and Syntax score in predicting 6-month MACE.

Abbreviations: NLR, neutrophil–lymphocyte ratio; PLR, platelet–lymphocyte ratio; hsCAR, high sensitivity C-reactive protein–albumin ratio.