Evaluation of Estimated Glucose Disposal Rate with Neutrophil-to-Lymphocyte Ratio Integrated for Prognosticating Adverse Cardiovascular and Cerebrovascular Events and Risk Stratification Among Acute Coronary Syndrome with Type 2 Diabetes Mellitus Following Percutaneous Coronary Intervention

Xunxun Feng; Yang Liu; Jiaqi Yang; Zhiming Zhou; Shiwei Yang; Yujie Zhou; Qianyun Guo

doi:10.2147/JIR.S490790

Evaluation of Estimated Glucose Disposal Rate with Neutrophil-to-Lymphocyte Ratio Integrated for Prognosticating Adverse Cardiovascular and Cerebrovascular Events and Risk Stratification Among Acute Coronary Syndrome with Type 2 Diabetes Mellitus Following Percutaneous Coronary Intervention

J Inflamm Res. 2024 Nov 20:17:9193-9214. doi: 10.2147/JIR.S490790. eCollection 2024.

Authors

Xunxun Feng^{1

2}, Yang Liu¹, Jiaqi Yang¹, Zhiming Zhou¹, Shiwei Yang¹, Yujie Zhou^#¹, Qianyun Guo^#¹

Affiliations

¹ 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.
² Department of Medicine, Division of Cardiology, University of California, Los Angeles, CA, USA.

^# Contributed equally.

Abstract

Objective: 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).

Methods: 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.

Results: 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; P < 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, P < 0.001).

Conclusion: 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.

Keywords: acute coronary syndrome; estimated glucose disposal rate; neutrophil-to-lymphocyte ratio; percutaneous coronary intervention; type 2 diabetes mellitus.

Grants and funding

XXF was supported by the grant from China Scholarship Council (CSC) (Grant No. 202308110233). QYG was supported by the grant from Beijing Hospitals Authority Youth Programme (Grant No. QML20210601) and National Natural Science Foundation of China (Grant No. 82300368). YJZ was supported by National Key Research and Development Program of China (Grant No. 2022YFC3602500), Beijing Municipal Administration of Hospitals’ Mission plan (Grant No. SML20180601), Capital’s Funds for Health Improvement and Research (Grant No. CFH 2020-2-2063), National Natural Science Foundation of China (Grant No. 82070293), and Beijing Municipal Natural Science Foundation (Grant No. 7202041).