Liu Jiahua, Du Xinjia, Ren Yanfei, Mei Yan, Chen Lei, Lu Yuan
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2025 Mar 26;12:1526057. doi: 10.3389/fcvm.2025.1526057. eCollection 2025.
BACKGROUND: Current research suggests that microvascular obstruction (MVO) following the first percutaneous coronary intervention (PCI) in myocardial infarction patients is closely related to inflammatory responses. The lymphocyte-to-C-reactive protein (CRP) ratio (LCR), as a novel inflammatory marker, is associated with the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). However, the relationship between LCR and MVO remains unclear. This study aims to investigate the correlation between LCR and MVO in STEMI patients undergoing PCI. METHODS: This was a single-center retrospective study. We consecutively enrolled STEMI patients who underwent PCI at Xuzhou Medical University Affiliated Hospital, Xuzhou, China, from September 2019 to December 2023. Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) was used to assess infarct size and the presence of MVO. RESULTS: A total of 551 patients were included in this study, with 267 (48.5%) experiencing MVO. The median time for CMR imaging-based detection of MVO was 5 days (interquartile range: 4, 6). Univariate regression analysis revealed that age, white blood cell count, neutrophil count, left ventricular ejection fraction (LVEF), peak N-terminal pro-B-type natriuretic peptide (NT-proBNP), peak high-sensitivity troponin T (hs-TnT), LCR, LGE percentage (LGE%), and MVO percentage (MVO%) were significantly associated with MVO ( < 0.05). Multivariate regression analysis identified LCR as an independent predictor of MVO [Odds Ratio = 0.18, 95% Confidence Interval (CI): 0.04-0.75, = 0.019]. Receiver operating characteristic curve analysis demonstrated that LCR had predictive capability for MVO, with a sensitivity of 80.1% and specificity of 45.4% when the LCR value was 0.091 [area under the curve (AUC): 0.654, 95% CI: 0.609-0.700, < 0.001]. A new predictive model incorporating LCR improved the prediction of MVO occurrence (AUC = 0.815, < 0.001), with significant differences in net reclassification improvement ( = 0.004) and integrated discrimination improvement ( = 0.023) between the new and old models. CONCLUSION: A low LCR is an independent risk factor for MVO after PCI in STEMI patients. The predictive model incorporating LCR enhances the ability to predict MVO occurrence in patients with STEMI post-PCI.
背景：目前的研究表明，心肌梗死患者首次经皮冠状动脉介入治疗（PCI）后的微血管阻塞（MVO）与炎症反应密切相关。淋巴细胞与C反应蛋白（CRP）比值（LCR）作为一种新型炎症标志物，与ST段抬高型心肌梗死（STEMI）患者的预后相关。然而，LCR与MVO之间的关系仍不清楚。本研究旨在探讨接受PCI的STEMI患者中LCR与MVO的相关性。 方法：这是一项单中心回顾性研究。我们连续纳入了2019年9月至2023年12月在中国徐州徐州医科大学附属医院接受PCI的STEMI患者。采用延迟钆增强（LGE）的心脏磁共振（CMR）成像来评估梗死面积和MVO的存在情况。 结果：本研究共纳入551例患者，其中267例（48.5%）发生MVO。基于CMR成像检测MVO的中位时间为5天（四分位间距：4，6）。单因素回归分析显示，年龄、白细胞计数、中性粒细胞计数、左心室射血分数（LVEF）、N末端B型利钠肽原（NT-proBNP）峰值、高敏肌钙蛋白T（hs-TnT）峰值、LCR、LGE百分比（LGE%）和MVO百分比（MVO%）与MVO显著相关（<0.05）。多因素回归分析确定LCR是MVO的独立预测因子[比值比=0.18，95%置信区间（CI）：0.04-0.75，=0.019]。受试者工作特征曲线分析表明，LCR对MVO具有预测能力，当LCR值为0.091时，敏感性为80.1%，特异性为45.4%[曲线下面积（AUC）：0.654，95%CI：0.609-0.700，<0.001]。纳入LCR的新预测模型改善了MVO发生的预测（AUC=0.815，<0.001），新旧模型在净重新分类改善（=0.004）和综合判别改善（=0.023）方面存在显著差异。 结论：低LCR是STEMI患者PCI术后发生MVO的独立危险因素。纳入LCR的预测模型增强了预测STEMI患者PCI术后MVO发生的能力。
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