Significance of Multiple Lymphocyte-to-C-Reactive Protein Ratios in Predicting Long-Term Major Cardiovascular Adverse Events in Emergency Percutaneous Coronary Intervention Patients with ST-Segment Elevation Myocardial Infarction

Figures & data

Table 1 Basic Clinical Characteristics Between MACE and Non-MACE Groups in STEMI Patients

Basic Clinical Characteristics	All, n=205	MACE group, n=86	Non-MACE group, n=119	P -value^b
Demographics
Age, years	63.00 (52.00, 69.00)	64.00 (55.75, 72.00)	61.00 (50.00, 76.00)	0.056
Male sex, n (%)	173 (84.40)	70 (81.40)	103 (86.60)	0.315
Smoking, n (%)	133 (64.90)	54 (62.80)	79 (66.40)	0.595
Hypertension, n (%)	126 (61.50)	56 (65.10)	70 (58.80)	0.361
Diabetes mellitus, n (%)	43 (21.00)	25 (29.10)	18 (15.10)	0.016
BMI (kg/m^2)	24.22 (22.84, 25.60)	24.16 (22.49, 25.26)	24.45 (23.03, 26.12)	0.072
Killip classification ≥ II, n (%)	67 (32.70)	43 (50.00)	24 (20.20)	<0.001
Time from pain to balloon (min)	106.00 (73.50, 146.50)	108.00 (70.50, 147.50)	140.00 (76.00, 143.00)	0.919
In-hospital day	11.00 (10.00, 13.50)	12.00 (9.75, 15.25)	11.00 (10.00, 13.00)	0.076
Prior medications
Beta-blocker, n (%)	161 (78.50)	64 (74.40)	97 (81.50)	0.222
ACEI/ARBs, n (%)	104 (500)	45 (52.30)	59 (49.60)	0.698
CCB, n (%)	20 (9.80)	5 (5.80)	12 (10.10)	0.274
Diuretic, n (%)	68 (33.20)	34 (30.50)	34 (28.60)	0.100
Nitrate, n (%)	71 (34.60)	34 (39.50)	37 (31.10)	0.210
Laboratory parameters
Heart rate (/min)	70.00 (66.00, 85.00)	70.00 (63.50, 86.00)	70.00 (68.00, 84.00)	0.639
Myoglobin (ng/dL)	96.50 (42.47, 305.03)	145.10 (53.41, 311.81)	95.42 (30.00, 287.70)	0.024
Glucose (mmol/L)	6.06 (5.23, 8.36)	6.81 (5.41, 10.62)	5.87 (5.10, 7.48)	0.008
Troponin I peak (ng/dL)	11.78 (3.37, 34.17)	12.88 (4.57, 40.96)	11.78 (2.65, 29.47)	0.146
Hemoglobin (g/L)	140.00 (129.00, 148.00)	140.00 (125.75, 149.25)	140.00 (130.00, 147.00)	0.883
Albumin (g/L)	36.84±3.89	36.55±4.55	37.05±3.35	0.359^a
Total cholesterol (mmol/L)	4.50 (3.86, 5.09)	4.42 (3.87, 5.12)	4.53 (3.83, 4.86)	0.269
Triglyceride (mmol/L)	1.52 (1.09, 2.04)	1.51 (1.08, 2.06)	1.52 (1.07, 2.03)	0.578
HDL cholesterol (mmol/L)	1.09 (0.93, 1.23)	1.08 (0.93, 1.18)	1.09 (0.92, 1.27)	0.434
LDL cholesterol (mmol/L)	2.64 (2.20, 3.00)	2.56 (2.19, 2.98)	2.64 (2.20, 3.07)	0.513
Serum creatinine (μmol/L)	75.00 (63.50, 88.00)	77.00 (62.00, 105.00)	73.00 (64.00, 84.00)	0.077
Fibrinogen (g/L)	3.11 (2.55, 3.79)	3.49 (2.80, 3.90)	2.87 (2.48, 3.52)	<0.001
D-dimer (mg/L)	0.41 (0.27, 0.81)	0.57 (0.31, 1.04)	0.37 (0.23, 0.54)	<0.001
Lipoprotein (a) (mg/L)	97.00 (55.00, 189.55)	128.50 (76.35, 251.00)	85.00 (42.00, 158.30)	0.001
Uric acid (μmol/L)	368.00 (291.50, 453.00)	394.00 (282.75, 510.25)	359.00 (294.00, 428.00)	0.076
Carotid artery calcification, n (%)	94 (45.90)	34 (39.50)	60 (50.40)	0.123
LVEF (%)	59.00 (57.00, 61.00)	58.00 (53.75, 60.00)	60.00 (58.00, 61.00)	<0.001
LVDd (mm)	46.00 (43.00, 49.00)	46.00 (44.00, 49.00)	46.00 (42.00, 49.00)	0.115
Mitral regurgitation, n (%)	108 (52.70)	56 (65.10)	52 (43.70)	0.002
Localization of MI, n (%)
Left main coronary artery, n (%)	9 (4.40)	6 (7.00)	3 (2.50)	0.234
Left anterior descending artery, n (%)	105 (51.20)	40 (46.50)	65 (54.60)	0.252
Left circumflex artery, n (%)	28 (13.70)	12 (14.00)	16 (13.40)	0.917
Right coronary artery, n (%)	63 (30.70)	28 (32.60)	35 (29.40)	0.630
Angiographic characteristics
Number of diseased arteries ≥ 2, n (%)	136 (66.30)	66 (76.70)	70 (58.80)	0.007
Mean stent diameter (mm)	3.00 (2.75, 3.25)	3.00 (2.75, 3.50)	3.00 (2.75, 3.25)	0.366
Total stent length (mm)	36.00 (27.00, 52.00)	36.00 (28.00, 58.25)	36.00 (24.00, 47.00)	0.049
No-reflow, n (%)	41 (20.00)	26 (30.20)	15 (12.60)	0.002
Gemini score	64.00 (42.50, 87.00)	80.00 (51.50, 99.50)	54.00 (40.00, 80.00)	<0.001
Inflammation indicators
LCR at admission	27.03 (8.29, 60.59)	17.65 (4.86, 31.64)	49.66 (13.96, 91.88)	<0.001
LCR at 24 hours post-PCI	2.64 (1.34, 5.43)	1.16 (0.68, 2.25)	4.73 (2.52, 8.36)	<0.001
LCR at discharge	25.85 (9.29, 71.18)	12.94 (5.22, 36.56)	42.31 (15.39, 88.64)	<0.001
LCR (admission-24 hours post-PCI)	23.65 (6.62, 55.79)	15.47 (3.91, 29.57)	35.70 (9.80, 82.88)	<0.001
LCR (discharge – 24 hours post-PCI)	21.88 (6.21, 66.45)	11.61 (3.68, 36.11)	34.57 (12.37, 75.50)	<0.001
LCR (discharge - at admission)	0.87 (−24.64, 26.57)	0.82 (−16.06, 18.33)	2.17 (−45.91, 29.50)	0.280

Notes: ^aUnpaired Student’s t-test. ^bMann–Whitney U-test and chi-square/Fisher’s exact test.

Abbreviations: MACEs, major adverse cardiovascular events; BMI, body mass index; ACEI/ARBs, angiotensinogen converting enzyme inhibitor/angiotensinogen receptor blockers; CCB, calcium channel blocker; HDL cholesterol, high-density lipoprotein cholesterol; LDL cholesterol, low-density lipoprotein cholesterol; LVEF, left ventricular ejection fraction; LVDd, Left ventricular end diastolic diameter; LCR, lymphocyte to C-reactive protein ratio; PCI, percutaneous coronary intervention.

Table 2 Univariate Cox Proportional Hazard Regression Analysis of MACEs Occurrence Within 1 Year of Hospital Discharge in Patients with STEMI After PCI

	Univariate Analysis
	P-value	HR	95% CI
Gensini score	<0.001	1.020	1.013	1.027
Diabetes mellitus, n (%)	0.016	1.770	1.111	2.821
Killip classification ≥ II, n (%)	<0.001	2.758	1.803	4.219
Myoglobin (ng/dL)	0.005	1.000	1.000	1.001
Lipoprotein (a) (mg/L)	0.006	1.001	1.000	1.002
Glucose (mmol/L)	<0.001	1.109	1.047	1.174
D-dimer (mg/L)	0.002	1.428	1141	1.788
Fibrinogen (g/L)	<0.001	1.322	1.138	1.535
LVEF (%)	<0.001	0.944	0.916	0.974
No-reflow, n (%)	0.002	2.085	1.315	3.309
Mitral regurgitation, n(%)	0.003	1.978	1.269	3.084
Number of diseased arteries ≥ 2, n (%)	0.006	2.017	1.223	3.328
Total stent length (mm)	0.014	1.015	1.003	1.027
LCR at admission	<0.001	0.987	0.980	0.994
LCR at 24 hours post-PCI	0.001	0.535	0.444	0.644
LCR at discharge	0.071	0.998	0.995	1.000
LCR (admission-24 hours post-PCI)	<0.001	0.990	0.984	0.996

Abbreviations: MACEs, major adverse cardiac events; PCI, percutaneous coronary intervention; LVEF, left ventricular ejection fraction; LCR, lymphocyte-to-C-reactive protein ratio; HR, hazard ratio; CI, confidence interval.

Table 3 Multivariable Cox Proportional Hazard Regression Analysis of MACEs Occurrence Within 1 Year of Hospital Discharge in Patients with STEMI After PCI

Multivariable Analysis
	Forward Likelihood Ratio				Backward Likelihood Ratio
	P-value	HR	95% CI		P-value	HR	95% CI
Gensini score	<0.001	1.016	1.009	1.024	<0.001	1.015	1.007	1.022
Total stent length (mm)	0.016	1.017	1.003	1.031	0.025	1.015	1.002	1.029
Lipoprotein (a) (mg/L)	0.032	1.001	1.000	1.002	0.043	1.001	1.000	1.002
LCR at admission					0.044	0.995	0.989	1.000
LCR at 24 hours post-PCI	<0.001	0.559	0.465	0.672	<0.001	0.587	0.486	0.708

Abbreviations: LCR, lymphocyte-to-C-reactive protein ratio; HR, hazard ratio; CI, confidence interval.

Figure 1 Receiver operating characteristic (ROC) curves. (A) ROC curve of LCR at admission in predicting MACEs; (B) ROC curve of LCR 24 hours post-PCI in predicting MACEs.

Figure 2 Kaplan–Meier survival analysis. (A) Patients with low LCR values at admission (LCR at admission ≤ 50.29) had a much higher risk of MACEs compared to that in patients with a high value (LCR at admission > 50.29); (B) Patients with a low value of LCR at 24 hours post-PCI (LCR at 24 hours post-PCI ≤ 2.25) had a much higher risk of MACEs compared to that in patients with a high value (LCR at 24 hours post-PCI > 2.25).

Figure 3 Kaplan–Meier survival analysis. (A) LCR at admission predicts the risk of cardiac death in STEMI patients; (B) LCR at 24 hours post-PCI predicts the risk of cardiac death in STEMI patients; (C) LCR at admission predicts the risk of heart failure in STEMI patients; (D) LCR at 24 hours post-PCI predicts the risk of heart failure in STEMI patients; (E) LCR at admission predicts the risk of unstable angina pectoris after stenting in STEMI patients; (F) LCR at 24 hours post-PCI predicts the risk of unstable angina pectoris after stenting in STEMI patients; (G) LCR at admission predicts the risk of non-fatal myocardial infarction in STEMI patients; (H) LCR at 24 hours post-PCI predicts the risk of non-fatal myocardial infarction in STEMI patients.

Abbreviations: UA, unstable angina; MI, myocardial infarction; LCR, lymphocyte-to-C-reactive protein ratio; PCI, percutaneous coronary intervention.

Figure 4 Correlation of LCR at 24 hours post-PCI with Gensini score, TIMI flow, and mitral regurgitation. (A) Spearman correlation analysis between Gensini score and LCR at 24 hours post-PCI; (B) The no-reflow group had a lower level of LCR at 24 hours post-PCI compared to that in the reflow group; (C) The mitral regurgitation group had a lower level of LCR at 24 hours post-PCI compared to that in the non-mitral regurgitation group.

Figure 5 Correlation of LCR at 24 hours post-PCI with Lp(a), D-dimer, fibrinogen and LVEF. (A) Spearman correlation analysis between Lp(a) and LCR at 24 hours post-PCI; (B) Spearman correlation analysis between D-dimer and LCR at 24 hours post-PCI; (C) Spearman correlation analysis between fibrinogen and LCR at 24 hours post-PCI; (D) Spearman correlation analysis between LVEF and LCR at 24 hours post-PCI.

Figure 6 Correlation of LCR at 24 hours post-PCI with diabetes mellitus, Killip class, and number of diseased arteries. (A) The diabetes mellitus group had a lower level of LCR at 24 hours post-PCI compared to that in the non-diabetes mellitus group; (B) The Killip class ≥ II group had a lower level of LCR at 24 hours post-PCI compared to that in the Killip class ≤ I group; (C) The number of diseased arteries ≥ 2 group had a lower level of LCR at 24 hours post-PCI compared to that in the number of diseased arteries ≤ 1 group.

Data Sharing Statement

Data from this study are available from the corresponding author upon request.