Prognosis and Risk Model Construction of Novel Inflammatory Marker Scores and Patients with ST-segment Elevation Myocardial Infarc-tion
Objective To develop and evaluate a novel inflammatory marker composite score to predict the risk of major adverse car-diac events(MACE)after percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STE-MI).Methods A total of 256 patients with STEMI admitted to the Third Medical Center of Chinese PLA General Hospital between June 2021 and May 2022 were selected.Six inflammatory markers[neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),red blood cell distribution width-to-platelet ratio(RPR),monocyte-to-lymphocyte ratio(MLR),monocyte-o-high-density lipoprotein ratio(MHR)and globulin-to-albumin ratio(GAR)]were collected on admission.The least absolute shrinkage and selection operator(LASSO)was used to determine the inflammatory markers of MACE risk,and a novel composite score of inflammatory markers was constructed based on the regression coefficient.COX risk regression models were used to analyze the relationship between this scores and MACE risk in STEMI patients.Nomogram models for quantifying MACE risk were constructed using a correlation R package.The model predictive performance and net clinical benefit were assessed by receiver operating characteristic(ROC)curve and clinical de-cision analysis(DCA)curve.Results In 256 STEMI patients followed up for a median of 11 months,52 patients developed MACE,with an incidence of 20.3％.The N.M.P score was constructed based on NLR,MHR and PLR[N.M.P score=(0.900 x NLR level)+(0.102 × MHR level)+(0.039 × PLR level)].Multivariate COX risk regression analysis showed that N.M.P score was not affected by age and SYNTAX score,and was independently associated with MACE risk independent(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of the nomogram model in predicting the risk of MACE at six months,one year and one and a half years were 0.905,0.920 and 0.897,respectively.DC A curve analysis showed that the nomogram model could provide a significant clinical net ben-efits.Conclusion The N.M.P score developed by integrating NLR,MHR and PLR are effective in predicting the risk of MACE in STE-MI patients.A nomogram model constructed to quantify the risk of MACE in STEMI patients based on the N.M.P score combined with age and SYNTAX score is useful for risk stratification and the development of secondary prevention strategies.
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