Feng Xunxun, Liu Yang, Yang Jiaqi, Zhou Zhiming, Yang Shiwei, Zhou Yujie, Guo Qianyun
Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Clinical Center for Coronary Heart Disease, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Medicine, Division of Cardiology, University of California, Los Angeles, CA, USA.
J Inflamm Res. 2024 Nov 20;17:9193-9214. doi: 10.2147/JIR.S490790. eCollection 2024.
This research aimed to address the critical need for effective prognostic tools in patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) undergoing percutaneous coronary intervention (PCI) by exploring the potential significance of integrating estimated glucose disposal rate (eGDR) and neutrophil-to-lymphocyte ratio (NLR).
Major adverse cardiovascular and cerebrovascular events (MACCE) were the primary endpoint. Log rank test was conducted to compare the Kaplan-Meier curves across the overall follow-up period, and multivariate Cox regression was used to investigate the association between the eGDR/NLR and MACCE.
One hundred fifty-four patients (9.5%) experienced MACCE including 15 cardiac deaths, 97 nonfatal MI, 120 TVR, and 10 strokes. Patients were distributed into low and high eGDR/NLR groups (lower eGDR [eGDR-L] group, higher eGDR [eGDR-H] group, lower NLR [NLR-L] group, and higher NLR [NLR-H] group) based on the median value of eGDR and NLR, further divided into four groups: eGDR-L + NLR-L, eGDR-H + NLR-L, eGDR-L + NLR-H, and eGDR-H + NLR-H. eGDR-L + NLR-H group exhibited significantly higher risks of MACCE (17.4%), compared to another three groups. An independent correlation between eGDR/NLR and MACCE was demonstrated by Cox regression analysis, establishing if the eGDR and NLR was treated as a continuous or categorical variable. Compared to eGDR-H + NLR-L group, patients in eGDR-L + NLR-H group had the uppermost MACCE risk (HR: 5.201; 95% CI 2.764-7.786; < 0.001). A linear relationship between eGDR/ NLR and MACCE was showed by restricted cubic spline curves. Incorporating the eGDR and NLR toward the baseline risk model developed the precision of forecasting MACCE (baseline risk model-AUC: 0.611 vs baseline risk model + eGDR + NLR-AUC: 0.695, < 0.001).
Combining eGDR with NLR can be utilized to forecast long-term MACCE and substantially improve the accuracy of risk stratification in ACS patients with T2DM following PCI.
本研究旨在通过探讨整合估计葡萄糖处置率（eGDR）和中性粒细胞与淋巴细胞比值（NLR）的潜在意义，满足急性冠状动脉综合征（ACS）合并2型糖尿病（T2DM）且接受经皮冠状动脉介入治疗（PCI）患者对有效预后工具的迫切需求。
主要不良心血管和脑血管事件（MACCE）为主要终点。进行对数秩检验以比较整个随访期的Kaplan-Meier曲线，并使用多变量Cox回归研究eGDR/NLR与MACCE之间的关联。
154例患者（9.5%）发生MACCE，包括15例心源性死亡、97例非致命性心肌梗死、120例靶血管重建和10例中风。根据eGDR和NLR的中位数将患者分为低eGDR/NLR组（低eGDR [eGDR-L]组、高eGDR [eGDR-H]组、低NLR [NLR-L]组和高NLR [NLR-H]组），进一步分为四组：eGDR-L + NLR-L、eGDR-H + NLR-L、eGDR-L + NLR-H和eGDR-H + NLR-H。与其他三组相比，eGDR-L + NLR-H组表现出显著更高的MACCE风险（17.4%）。Cox回归分析证实了eGDR/NLR与MACCE之间的独立相关性，无论将eGDR和NLR视为连续变量还是分类变量。与eGDR-H + NLR-L组相比，eGDR-L + NLR-H组患者的MACCE风险最高（HR：5.201；95% CI 2.764 - 7.786；< 0.001）。受限立方样条曲线显示了eGDR/NLR与MACCE之间的线性关系。将eGDR和NLR纳入基线风险模型提高了预测MACCE的准确性（基线风险模型-AUC：0.611 vs 基线风险模型 + eGDR + NLR-AUC：0.695，< 0.001）。
联合eGDR与NLR可用于预测长期MACCE，并显著提高PCI术后合并T2DM的ACS患者风险分层的准确性。
