Value of Early Risk Stratification Using Hemoglobin Level and Neutrophil-to-Lymphocyte Ratio in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Value of Early Risk Stratification Using Hemoglobin Level and Neutrophil-to-Lymphocyte Ratio in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
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DOI：
10.1016/j.amjcard.2010.10.067
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发表时间：
2011-03-15
影响因子：
2.8
通讯作者：
Kang, Jung Chaee
中科院分区：
文献类型：
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作者：
Cho, Kyung Hoon;Jeong, Myung Ho;Kang, Jung Chaee
全血细胞计数是ST段抬高型心肌梗死（STEMI）后早期住院期间最广泛使用的实验室数据。我们评估了联合使用血红蛋白（Hb）水平和嗜中性粒细胞/淋巴细胞比率（NIL）对STEMI患者进行早期风险分层的临床效用。我们分析了801例在症状发作12小时内接受直接经皮冠状动脉介入治疗（PCI）的STEMI患者。排除心源性休克或潜在恶性肿瘤患者，最终分析纳入739例患者（63 ± 13岁，74%为男性）。使用N/L的中位数将患者分为3组（3.86）和贫血的存在（男性Hb < 13 mg/dl，女性< 12 mg/dl）; I组低N/L且无贫血（n = 272），II组低N/L且贫血，或高N/L且无贫血（n = 331），III组高N/L且贫血（n = 136）。3组患者6个月随访时临床结局差异有统计学意义。联合使用Hb水平和NIL的预后判别能力在高风险亚组中也是显著的，例如高龄、糖尿病、多支冠状动脉疾病、低射血分数的患者，甚至在基于心肌梗死溶栓风险评分的死亡风险较高的患者中。在考克斯比例风险模型中，在调整多个协变量后，第III组6个月时的死亡率高于第I组（风险比5.6，95%置信区间1.1 - 27.9，p = 0.036）。总之，Hb水平和N/L的联合使用为行直接PCI的STEMI患者的早期风险分层提供了有价值的及时信息。(C)2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107：849-856）
Complete blood count is the most widely available laboratory datum in the early in-hospital period after ST-elevation myocardial infarction (STEMI). We assessed the clinical utility of the combined use of hemoglobin (Hb) level and neutrophil-to-lymphocyte ratio (NIL) for early risk stratification in patients with STEMI. We analyzed 801 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) within 12 hours of onset of symptoms. Patients with cardiogenic shock or underlying malignancy were excluded, and 739 patients (63 +/- 13 years, 74% men) were included in the final analysis. Patients were categorized into 3 groups using the median value of N/L (3.86) and the presence of anemia (Hb < 13 mg/dl in men and < 12 mg/di in women); group I had low N/L and no anemia (n = 272), group II had low N/L and anemia, or high N/L and no anemia (n = 331), and group III had high N/L and anemia (n = 136). There were significant differences on clinical outcomes during 6-month follow-up among the 3 groups. Prognostic discriminatory capacity of combined use of Hb level and NIL was also significant in high-risk subgroups such as patients with advanced age, diabetes mellitus, multivessel coronary disease, low ejection fraction, and even in those having higher mortality risk based on Thrombolysis In Myocardial Infarction risk score. In a Cox proportional hazards model, after adjusting for multiple covariates, group III had higher mortality at 6 months (hazard ratio 5.6, 95% confidence interval 1.1 to 27.9, p = 0.036) compared to group I. In conclusion, combined use of Hb level and N/L provides valuable timely information for early risk stratification in patients with STEMI undergoing primary PCI. (C) 2011 Elsevier Inc. All rights reserved. (Am J Cardiol 2011;107:849-856)