Xunxun Feng,1,2 Yang Liu,1 Jiaqi Yang,1 Zhiming Zhou,1 Shiwei Yang,1 Yujie Zhou,1,* Qianyun Guo1,* 

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

*These authors contributed equally to this work

Correspondence: Yujie Zhou; Qianyun Guo, Email azzyj12@163.com; gqydyx3000@163.com

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