Journal of Southern Medical University ›› 2026, Vol. 46 ›› Issue (10): 2405-2414.doi: 10.12122/j.issn.1673-4254.2026.10.10
Mengru HE1(
), Chuan JIN1, Yixuan YU3, Jingxian WANG1, Xu TONG1, Muyan CHEN3, Hongwei SONG2, Ying WANG2, Li ZHOU2, Jun WANG1, Hongju WANG1, Miaonan LI1()
Received:2026-03-20
Online:2026-10-20
Published:2026-10-26
Contact:
Miaonan LI
E-mail:3021997475@qq.com;13855265385@163.com
Mengru HE, Chuan JIN, Yixuan YU, Jingxian WANG, Xu TONG, Muyan CHEN, Hongwei SONG, Ying WANG, Li ZHOU, Jun WANG, Hongju WANG, Miaonan LI. Myocardium global longitudinal strain and peripheral blood neutrophil-to-lymphocyte ratio for predicting MACE risks following percutaneous coronary intervention for first-time acute myocardial infarction: a prospective cohort study[J]. Journal of Southern Medical University, 2026, 46(10): 2405-2414.
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URL: https://www.j-smu.com/EN/10.12122/j.issn.1673-4254.2026.10.10
Fig.1 Flow chart of patient enrollment and grouping.
| Characteristics | Non-MACEs group (n=103) | MACEs group (n=31) | P |
|---|---|---|---|
| Age (year) | 59±11 | 64±12 | 0.041 |
| Male [n (%)] | 79 (76.7%) | 20 (64.5%) | 0.176 |
| BMI (kg/m2) | 25.0±3.7 | 25.0±3.2 | 0.921 |
| Hypertension [n (%)] | 61 (59.2%) | 15 (48.4%) | 0.286 |
| Diabetes [n (%)] | 25 (24.3%) | 9 (29.0%) | 0.593 |
| AF [n (%)] | 4 (3.9%) | 4 (12.9%) | 0.083 |
| Previous stroke [n (%)] | 8 (7.8%) | 4 (12.9%) | 0.472 |
| Previous smoking [n (%)] | 59 (57.3%) | 17 (54.8%) | 0.810 |
| WBC (109/L) | 9.69 (8.04, 11.47) | 11.47 (10.29, 13.49) | <0.001 |
| Neutrophil (109/L) | 7.37 (5.71, 9.22) | 9.56 (8.55, 11.66) | <0.001 |
| Lymphocyte (109/L) | 0.48 (0.36, 0.67) | 0.48 (0.27, 0.61) | 0.364 |
| Monocyte (109/L) | 1.43 (1.13, 2.01) | 1.02 (0.88, 1.39) | <0.001 |
| Platelet (109/L) | 205 (168, 240) | 214 (171, 254) | 0.388 |
| NLR | 5.3 (3.2, 7.0) | 9.2 (7.4, 12.4) | <0.001 |
| PLR | 142 (93, 182) | 173 (142, 254) | <0.001 |
| FBG (mmol/L) | 6.5 (5.4, 8.2) | 6.3 (5.1, 8.8) | 0.959 |
| UA (µmol/L) | 315 (259, 381) | 334 (260, 394) | 0.513 |
| SCr (µmol/L) | 62 (51, 74) | 66 (51, 82) | 0.593 |
| TC (mmol/L) | 4.35 (3.73, 5.25) | 4.80 (4.13, 5.53) | 0.110 |
| TG (mmol/L) | 1.52 (1.02, 2.09) | 1.32 (0.89, 2.08) | 0.754 |
| LDL-C (mmol/L) | 2.77 (2.07, 3.38) | 2.93 (2.40, 3.66) | 0.297 |
| HDL-C (mmol/L) | 1.05 (0.89, 1.22) | 1.13 (0.98, 1.39) | 0.129 |
| CK-MB(U/L) | 40 (20, 100) | 38 (20, 141) | 0.829 |
| cTn I (μg/L) | 11 (3, 22) | 8 (1, 47) | 0.827 |
| NT-proBNP(pg/mL) | 258 (61, 697) | 1,030 (123, 2,330) | 0.001 |
Tab.1 Baseline characteristics of the two groups of AMI patients
| Characteristics | Non-MACEs group (n=103) | MACEs group (n=31) | P |
|---|---|---|---|
| Age (year) | 59±11 | 64±12 | 0.041 |
| Male [n (%)] | 79 (76.7%) | 20 (64.5%) | 0.176 |
| BMI (kg/m2) | 25.0±3.7 | 25.0±3.2 | 0.921 |
| Hypertension [n (%)] | 61 (59.2%) | 15 (48.4%) | 0.286 |
| Diabetes [n (%)] | 25 (24.3%) | 9 (29.0%) | 0.593 |
| AF [n (%)] | 4 (3.9%) | 4 (12.9%) | 0.083 |
| Previous stroke [n (%)] | 8 (7.8%) | 4 (12.9%) | 0.472 |
| Previous smoking [n (%)] | 59 (57.3%) | 17 (54.8%) | 0.810 |
| WBC (109/L) | 9.69 (8.04, 11.47) | 11.47 (10.29, 13.49) | <0.001 |
| Neutrophil (109/L) | 7.37 (5.71, 9.22) | 9.56 (8.55, 11.66) | <0.001 |
| Lymphocyte (109/L) | 0.48 (0.36, 0.67) | 0.48 (0.27, 0.61) | 0.364 |
| Monocyte (109/L) | 1.43 (1.13, 2.01) | 1.02 (0.88, 1.39) | <0.001 |
| Platelet (109/L) | 205 (168, 240) | 214 (171, 254) | 0.388 |
| NLR | 5.3 (3.2, 7.0) | 9.2 (7.4, 12.4) | <0.001 |
| PLR | 142 (93, 182) | 173 (142, 254) | <0.001 |
| FBG (mmol/L) | 6.5 (5.4, 8.2) | 6.3 (5.1, 8.8) | 0.959 |
| UA (µmol/L) | 315 (259, 381) | 334 (260, 394) | 0.513 |
| SCr (µmol/L) | 62 (51, 74) | 66 (51, 82) | 0.593 |
| TC (mmol/L) | 4.35 (3.73, 5.25) | 4.80 (4.13, 5.53) | 0.110 |
| TG (mmol/L) | 1.52 (1.02, 2.09) | 1.32 (0.89, 2.08) | 0.754 |
| LDL-C (mmol/L) | 2.77 (2.07, 3.38) | 2.93 (2.40, 3.66) | 0.297 |
| HDL-C (mmol/L) | 1.05 (0.89, 1.22) | 1.13 (0.98, 1.39) | 0.129 |
| CK-MB(U/L) | 40 (20, 100) | 38 (20, 141) | 0.829 |
| cTn I (μg/L) | 11 (3, 22) | 8 (1, 47) | 0.827 |
| NT-proBNP(pg/mL) | 258 (61, 697) | 1,030 (123, 2,330) | 0.001 |
| Characteristics | Non-MACEs group (n=103) | MACEs group (n=31) | P |
|---|---|---|---|
| Gensini score | 72 (46, 102) | 88 (75, 166) | 0.004 |
| Number of diseased vessels [n (%)] | 0.205 | ||
| One vessel disease | 26 (25.2%) | 4 (12.9%) | 0.148 |
| Two vessel disease | 25 (24.3%) | 6 (19.4%) | 0.569 |
| Three vessel disease | 52 (50.5%) | 21 (67.7%) | 0.091 |
| Anterior myocardial infarction | 47 (45.6%) | 27 (87.1%) | <0.001 |
| Culprit vessel [n (%)] | <0.001 | ||
| LAD | 44 (42.7%) | 24 (77.4%) | <0.001 |
| LCX | 15 (14.6%) | 4 (12.9%) | 0.815 |
| RCA | 44 (42.7%) | 3 (9.7%) | <0.001 |
| Chest pain TIMI classification [n (%)] | 0.011 | ||
| Low risk | 60 (58.3%) | 9 (29.0%) | 0.004 |
| Intermediate risk | 31 (30.1%) | 14 (45.2%) | 0.119 |
| High risk | 12 (11.7%) | 8 (25.8%) | 0.099 |
Tab.2 Comparison of coronary artery lesions between the two groups of AMI patients
| Characteristics | Non-MACEs group (n=103) | MACEs group (n=31) | P |
|---|---|---|---|
| Gensini score | 72 (46, 102) | 88 (75, 166) | 0.004 |
| Number of diseased vessels [n (%)] | 0.205 | ||
| One vessel disease | 26 (25.2%) | 4 (12.9%) | 0.148 |
| Two vessel disease | 25 (24.3%) | 6 (19.4%) | 0.569 |
| Three vessel disease | 52 (50.5%) | 21 (67.7%) | 0.091 |
| Anterior myocardial infarction | 47 (45.6%) | 27 (87.1%) | <0.001 |
| Culprit vessel [n (%)] | <0.001 | ||
| LAD | 44 (42.7%) | 24 (77.4%) | <0.001 |
| LCX | 15 (14.6%) | 4 (12.9%) | 0.815 |
| RCA | 44 (42.7%) | 3 (9.7%) | <0.001 |
| Chest pain TIMI classification [n (%)] | 0.011 | ||
| Low risk | 60 (58.3%) | 9 (29.0%) | 0.004 |
| Intermediate risk | 31 (30.1%) | 14 (45.2%) | 0.119 |
| High risk | 12 (11.7%) | 8 (25.8%) | 0.099 |
| Characteristics | Non-MACEs group (n=103) | MACEs group (n=31) | P |
|---|---|---|---|
| Myocardial mass (g) | 101 (85, 117) | 100 (87, 120) | 0.667 |
| LGE (%) | 16 (12, 25) | 22 (17, 33) | 0.011 |
| LVEDV/BSA (mL/m2 ) | 72 (61, 84) | 72 (61, 95) | 0.478 |
| LVESV/BSA (mL/m2 ) | 37 (28, 45) | 41 (35, 60) | 0.017 |
| LVEF (%) | 49 ± 10 | 40±11 | <0.001 |
| Reverse motion [n (%)] | 75 (72.8%) | 28 (90.3%) | 0.043 |
| MVO [n (%)] | 57 (55.3%) | 23 (74.2%) | 0.061 |
| MVO volume (mL) | 2.87 (1.03, 4.70) | 2.08 (0.92, 5.47) | 0.698 |
| Ventricular aneurysm [n (%)] | 16 (15.5%) | 16 (51.6%) | <0.001 |
| Myocardial strain in infarct segment [n (%)] | |||
| Radial strain | 16 (13, 22) | 12 (11, 17) | 0.003 |
| Circumferential strain | 11.5 (9.4, 14.1) | 10.1 (9.0, 11.4) | 0.018 |
| Longitudinal strain | 11.2 (9.0, 14.3) | 7.7 (6.7, 9.5) | <0.001 |
| Global myocardial strain | |||
| Radial strain | 26 (21, 32) | 24 (19, 26) | 0.018 |
| Circumferential strain | 15.11±3.10 | 13.57±2.77 | 0.011 |
| Longitudinal strain | 11.6 (9.3, 14.4) | 8.3 (6.8, 9.4) | <0.001 |
Tab.3 Comparison of cardiac magnetic resonance （CMR） parameters between the two groups of AMI patients
| Characteristics | Non-MACEs group (n=103) | MACEs group (n=31) | P |
|---|---|---|---|
| Myocardial mass (g) | 101 (85, 117) | 100 (87, 120) | 0.667 |
| LGE (%) | 16 (12, 25) | 22 (17, 33) | 0.011 |
| LVEDV/BSA (mL/m2 ) | 72 (61, 84) | 72 (61, 95) | 0.478 |
| LVESV/BSA (mL/m2 ) | 37 (28, 45) | 41 (35, 60) | 0.017 |
| LVEF (%) | 49 ± 10 | 40±11 | <0.001 |
| Reverse motion [n (%)] | 75 (72.8%) | 28 (90.3%) | 0.043 |
| MVO [n (%)] | 57 (55.3%) | 23 (74.2%) | 0.061 |
| MVO volume (mL) | 2.87 (1.03, 4.70) | 2.08 (0.92, 5.47) | 0.698 |
| Ventricular aneurysm [n (%)] | 16 (15.5%) | 16 (51.6%) | <0.001 |
| Myocardial strain in infarct segment [n (%)] | |||
| Radial strain | 16 (13, 22) | 12 (11, 17) | 0.003 |
| Circumferential strain | 11.5 (9.4, 14.1) | 10.1 (9.0, 11.4) | 0.018 |
| Longitudinal strain | 11.2 (9.0, 14.3) | 7.7 (6.7, 9.5) | <0.001 |
| Global myocardial strain | |||
| Radial strain | 26 (21, 32) | 24 (19, 26) | 0.018 |
| Circumferential strain | 15.11±3.10 | 13.57±2.77 | 0.011 |
| Longitudinal strain | 11.6 (9.3, 14.4) | 8.3 (6.8, 9.4) | <0.001 |
Fig.2 A 71-year-old female patient with anterior myocardial infarction showing significantly reduced global longitudinal strain with paradoxical motion. She experienced a major adverse cardiovascular events (MACEs) 17 months after percutaneous coronary intervention (PCI).
Fig.3 A 70-year-old male patient with inferior wall myocardial infarction showing no significant decrease in global longitudinal strain. He remained free of MACEs 22 months after PCI.
Fig.4 Based on the variable screening results of LASSO regression (λ.1se criterion), 4 indicators were selected: NLR, GLS, NT proBNP, and ventricular aneurysm (n=134).
Fig.5 10-fold cross validation curve of LASSO regression (n=134).
| Index | β | SE | Wald | P | OR | 95% CI |
|---|---|---|---|---|---|---|
| NLR | 0.371 | 0.096 | 15.037 | <0.001 | 1.449 | 1.201-1.747 |
| GLS | -0.475 | 0.132 | 12.946 | <0.001 | 0.622 | 0.480-0.805 |
| NT-proBNP | 0.020 | 0.015 | 1.732 | 0.188 | 1.020* | 0.990-1.051 |
| Ventricular aneurysm | 0.563 | 1.282 | 0.870 | 0.351 | 1.755 | 0.538-5.726 |
Tab.4 Multivariate logistic regression analysis of factors affecting post-PCI MACEs
| Index | β | SE | Wald | P | OR | 95% CI |
|---|---|---|---|---|---|---|
| NLR | 0.371 | 0.096 | 15.037 | <0.001 | 1.449 | 1.201-1.747 |
| GLS | -0.475 | 0.132 | 12.946 | <0.001 | 0.622 | 0.480-0.805 |
| NT-proBNP | 0.020 | 0.015 | 1.732 | 0.188 | 1.020* | 0.990-1.051 |
| Ventricular aneurysm | 0.563 | 1.282 | 0.870 | 0.351 | 1.755 | 0.538-5.726 |
| Index | β | SE | Wald | P | OR | 95% CI |
|---|---|---|---|---|---|---|
| NLR | 0.388 | 0.092 | 17.946 | <0.001 | 1.475 | 1.232-1.765 |
| GLS | -0.531 | 0.129 | 16.804 | <0.001 | 0.588 | 0.456-0.758 |
| Constant | 1.160 | 1.224 | 0.898 | - | 3.190 | - |
Tab.5 Binary logistic regression analysis of GLS and NLR for predicting MACEs
| Index | β | SE | Wald | P | OR | 95% CI |
|---|---|---|---|---|---|---|
| NLR | 0.388 | 0.092 | 17.946 | <0.001 | 1.475 | 1.232-1.765 |
| GLS | -0.531 | 0.129 | 16.804 | <0.001 | 0.588 | 0.456-0.758 |
| Constant | 1.160 | 1.224 | 0.898 | - | 3.190 | - |
| Parameter | Cutoff value | Sensitivity(%) | Specificity(%) | AUC | 95% CI | Youden index |
|---|---|---|---|---|---|---|
| NLR | 7.223 | 0.774 | 0.777 | 0.820 | 0.735-0.905 | 0.551 |
| GLS | -9.65 | 0.839 | 0.718 | 0.825 | 0.740-0.910 | 0.557 |
| Joint prediction | 0.303 | 0.839 | 0.883 | 0.911 | 0.858-0.965 | 0.722 |
Tab.6 Predictive model for the risk of MACEs
| Parameter | Cutoff value | Sensitivity(%) | Specificity(%) | AUC | 95% CI | Youden index |
|---|---|---|---|---|---|---|
| NLR | 7.223 | 0.774 | 0.777 | 0.820 | 0.735-0.905 | 0.551 |
| GLS | -9.65 | 0.839 | 0.718 | 0.825 | 0.740-0.910 | 0.557 |
| Joint prediction | 0.303 | 0.839 | 0.883 | 0.911 | 0.858-0.965 | 0.722 |
Fig.6 ROC curve of MACEs predicted by NLR, GLS and their combination (n=134).
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