Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom.
Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom.
Thromb Haemost. 2019 Nov;119(11):1785-1794. doi: 10.1055/s-0039-1695007. Epub 2019 Aug 22.
Patients with ST-elevation myocardial infarction (STEMI) exhibit pro-thrombotic and pro-inflammatory states. Markers of enhanced platelet reactivity and inflammation are predictive of adverse outcome. However, the relationship between these biomarkers, and their combined usefulness for risk stratification, is not clear.
In a prospective study of 541 patients presenting with STEMI, blood samples were taken on arrival to measure high-sensitivity C-reactive protein (hs-CRP), neutrophil/lymphocyte ratio (NLR) and platelet reactivity using the point-of-care Global Thrombosis Test. These biomarkers, alone and in combination, were related to the occurrence of major adverse cardiovascular events (MACE, defined as composite of cardiovascular death, myocardial infarction and cerebrovascular accident) at 30 days and 12 months.
Platelet reactivity and hs-CRP, but not NLR, were weakly predictive of MACE at 30 days and 12 months. The combination of enhanced platelet reactivity and raised hs-CRP was strongly predictive of MACE at 30 days (hazard ratio [HR] 3.46 [95% confidence interval [CI] 1.81-6.62], < 0.001) and 12 months (HR 3.46 [95% CI 1.81-6.63], < 0.001). Combination of all three biomarkers (NLR, hs-CRP and platelet reactivity) provided the best prediction of MACE at 30 days (HR 3.73 [95% CI 1.69-8.27], < 0.001) and 12 months (HR 3.85 [95% CI 1.72-8.60], < 0.001), and improved the prediction of MACE when added to Thrombolysis In Myocardial Infarction score (net reclassification index 0.296, < 0.001).
A combination of three easy to measure biomarkers on arrival, namely hs-CRP, NLR and platelet reactivity, can help identify STEMI patients at high risk of recurrent adverse events over the subsequent year.
ST 段抬高型心肌梗死（STEMI）患者表现出促血栓形成和促炎状态。增强的血小板反应性和炎症标志物可预测不良预后。然而，这些生物标志物之间的关系及其联合用于风险分层的效果尚不清楚。
在一项对 541 例 STEMI 患者的前瞻性研究中，在入院时采集血样，使用即时检测的全球血栓检测来测量高敏 C 反应蛋白（hs-CRP）、中性粒细胞/淋巴细胞比值（NLR）和血小板反应性。这些生物标志物单独或联合用于预测 30 天和 12 个月时的主要不良心血管事件（MACE，定义为心血管死亡、心肌梗死和脑血管意外的复合事件）的发生。
血小板反应性和 hs-CRP，但不是 NLR，对 30 天和 12 个月时的 MACE 有弱预测性。增强的血小板反应性和升高的 hs-CRP 联合对 30 天（危险比 [HR]3.46 [95%置信区间 [CI]1.81-6.62]， < 0.001）和 12 个月（HR 3.46 [95% CI 1.81-6.63]， < 0.001）的 MACE 有强烈的预测作用。联合所有三种生物标志物（NLR、hs-CRP 和血小板反应性）对 30 天（HR 3.73 [95% CI 1.69-8.27]， < 0.001）和 12 个月（HR 3.85 [95% CI 1.72-8.60]， < 0.001）时的 MACE 有最佳预测作用，并在添加到心肌梗死溶栓治疗评分后提高了 MACE 的预测作用（净重新分类指数 0.296， < 0.001）。
入院时联合检测三种易于测量的生物标志物（hs-CRP、NLR 和血小板反应性），可以帮助识别在随后的 1 年内发生复发性不良事件风险较高的 STEMI 患者。
