Combination of D-dimer level and neutrophil to lymphocyte ratio predicts long-term clinical outcomes in acute coronary syndrome after percutaneous coronary intervention.
Combination of D-dimer level and neutrophil to lymphocyte ratio predicts long-term clinical outcomes in acute coronary syndrome after percutaneous coronary intervention.
复制标题
D-二聚体水平和中性粒细胞与淋巴细胞比率的组合可预测经皮冠状动脉介入治疗后急性冠状动脉综合征的长期临床结果
DOI：
10.5603/cj.a2021.0097
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发表时间：
2023
影响因子：
2.9
通讯作者：
Wang LS
中科院分区：
文献类型：
--
作者：
Gu LF;Gu J;Wang SB;Wang H;Wang YX;Xue Y;Wei TW;Sun JT;Lian XQ;Liu JB;Jia EZ;Wang LS
背景：高d -二聚体（DD）与急性冠脉综合征（ACS）患者的短期不良结局相关。然而，在接受经皮冠状动脉介入治疗（PCI）的ACS患者中，DD（或联合中性粒细胞与淋巴细胞比值[NLR]）预测长期主要不良心血管事件（mace）的价值尚未得到充分评估。方法纳入诊断为ACS并接受PCI治疗的患者。主要终点为mace。采用Cox比例风险回归和logistic回归分析临床危险因素、生物标志物与mace之间的关系。基于显著因素建立生存模型，并用协和指数（C-index）进行评估。结果最终的研究队列包括650例患者（中位年龄64岁，男性474例），其中98例（15%）患有mace，中位随访期为40个月。根据DD和NLR的临界值，将患者分为DD高或DD不高、NLR高或不高四组。校正混杂变量后，DD（校正风险比[aHR]: 2.39, 95%可信区间[CI]: 1.52-3.76）和NLR （aHR: 2.71, 95% CI: 1.78-4.11）与长期mace独立相关。此外，当考虑非高DD和NLR的患者作为参考时，高DD和NLR的患者发生mace的风险明显更高（aHR: 6.19, 95% CI: 3.30-11.61）。当DD和NLR联合使用时，区分长期mace的曲线下面积增加，达到0.70，合并两者的生存模型显示出更强的预测能力（c指数：0.75）。结论d -二聚体（或联合NLR）可用于预测ACS PCI患者的长期mace。
Background High D-dimer (DD) is associated with short-term adverse outcomes in patients with acute coronary syndrome (ACS). In ACS patients who underwent percutaneous coronary intervention (PCI), however, the value of DD (or combined with neutrophil to lymphocyte ratio [NLR]) to predict long-term major adverse cardiovascular events (MACEs) has not been fully evaluated. Methods Patients diagnosed with ACS and receiving PCI were included. The primary outcome was MACEs. Cox proportional hazards regression and logistic regression were used to illustrate the relationship between clinical risk factors, biomarkers and MACEs. Survival models were developed based on significant factors and evaluated by the Concordance-index (C-index). Results The final study cohort was comprised of 650 patients (median age, 64 years; 474 males), including 98 (15%) with MACEs during a median follow-up period of 40 months. According to the cut-off value of DD and NLR, the patients were separated into four groups: high DD or nonhigh DD with high or nonhigh NLR. After adjusting for confounding variables, DD (adjusted hazard ratio [aHR]: 2.39, 95% confidence interval [CI]: 1.52–3.76) and NLR (aHR: 2.71, 95% CI: 1.78–4.11) were independently associated with long-term MACEs. Moreover, patients with both high DD and NLR had a significantly higher risk in MACEs when considering patients with nonhigh DD and NLR as reference (aHR: 6.19, 95% CI: 3.30–11.61). The area under curve increased and reached 0.70 in differentiating long-term MACEs when DD and NLR were combined, and survival models incorporating the two exhibited a stronger predictive power (C-index: 0.75). Conclusions D-dimer (or combined with NLR) can be used to predict long-term MACEs in ACS patients undergoing PCI.