Predictive value of novel inflammatory markers combined with GRACE score for in-hospital outcome in patients with ST-segment elevation myocardial infarction: a retrospective observational study.

Abstract

Objectives: To assess the prognostic efficacy of innovative inflammatory indicators, specifically the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), in conjunction with the Global Registry of Acute Coronary Events (GRACE) score, for predicting adverse in-hospital outcomes among patients diagnosed with ST-segment elevation myocardial infarction (STEMI).

Design and setting: This study is a single-centre retrospective analysis of patients with STEMI treated at the Cardiology Department of Tianjin Third Central Hospital between 1 January 2018 and 31 December 2023. All data were sourced from the hospital's medical record system.

Outcome measures: The integration of the GRACE score with NLR and PLR facilitated the creation of an innovative predictive model. The model's predictive efficacy for in-hospital major adverse cardiovascular event (MACE) occurrence was assessed through receiver operating characteristic (ROC) curve analysis and multivariate logistic regression. Additionally, the Net Reclassification Improvement and Integrated Discrimination Improvement were computed to quantify enhancements in predictive value.

Results: Patients were stratified into the MACE (N=167) and the non-MACE group (N=1011) based on the incidence of MACE. A comparison of baseline characteristics between the two groups revealed 13 potential confounding variables. The NLR and PLR levels were converted into binary variables using ROC curve analysis. Univariate logistic regression indicated that both NLR and PLR were significant risk factors for MACE during hospitalisation. After adjusting for confounders, multivariate logistic regression confirmed NLR as an independent predictor of MACE risk in this cohort. Furthermore, both NLR and PLR augmented the predictive accuracy of the GRACE score, with their combined use offering a significant improvement in its predictive capacity.

Conclusions: The NLR possesses the capability to independently forecast the risk of MACE during the hospitalisation period for patients diagnosed with STEMI. The incorporation of the PLR and NLR with the GRACE score serves to augment its predictive precision.