Could lymphocyte-based inflammatory indices, RDW, PNI and AST/ALT ratio refine the clinical outcome in STEMIpatients undergoing primary percutaneous coronary intervention (PPCI)? a possible new predictor

Background
New lymphocyte‐based inflammatory indices [monocyte‐lymphocyte ratio (MLR), neutrophil‐lymphocyte ratio (NLR), platelet‐lymphocyte ratio (PLR), systemic immune inflammation index (SII)], red blood cell distribution width (RDW), prognostic nutrition index (PNI), and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, can reflect both inflammatory and nutritional state, all can provide prognostic information.


Objectives
To assess the MLR, NLR, PLR, SII, RDW, PNI, and AST/ALT ratio, their relation to severity indices [SYNTAX, GENSINI, TIMI risk scores, and EF%], and validity for prediction of primary, secondary outcome and major adverse cardiovascular events (MACEs) in STEMI patients who underwent PPCI.


Patients and methods
This retrospective study included 90 consecutive STEMI patients who underwent PPCI from January 2020 to June 2023. Admission blood samples for the MLR, NLR, PLR, SII, RDW, PNI, and AST/ALT ratio were measured. To assess the severity (SYNTAX, GENSINI, and TIMI risk scores) were used.


Results
STEMI patients who experienced adverse events had higher MLR, NLR, PLR, SII, and AST/ALT ratio, lower PNI. RDW had a moderate positive correlation with SYNTAX score (r=0.216, P=0.041). AST/ALT ratio had a moderate negative correlation with EF% (r=–0.242, P=0.021). SII index (aOR = 1.01, 95% CI: 1.003–1.009, P<0.001) and AST/ALT ratio (aOR = 1.53, 95% CI: 1.11–2.12, P=0.009), are significant predictors of primary, secondary outcome and MACEs after PPCI.


Conclusion
The MLR, NLR, PLR, SII, RDW, PNI, and AST/ALT ratio, simple, rapid laboratory tests may refine the risk assessment in STEMI patients to improve their outcome.