Prognostic value of the apelin-12-to-white blood cell ratio for long-term major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a retrospective cohort study.
- 1Department of Cardiac Surgical Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
Abstract
Despite advances in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), patients remain at risk for long-term major adverse cardiovascular events (MACEs). The apelin-12/white blood cell ratio (AWR), a ratio has never been studied before, may reflect the balance between cardioprotective apelin signaling and systemic inflammation. We examined the prognostic value of admission AWR for long-term MACEs in STEMI patients after primary PCI. This secondary analysis included 464 consecutive STEMI patients who underwent primary PCI at The First People's Hospital of Taizhou (Zhejiang, China) between January 2010 and October 2014. Blood samples were collected on admission, immediately before primary PCI, for apelin-12 measurement. Patients were followed for 30 months. MACE was defined as the composite of cardiac death, cardiogenic shock, congestive heart failure, recurrent target-vessel myocardial infarction, or clinically driven target-lesion revascularization. AWR was analyzed as a continuous variable and by pre-specified tertiles (cut-points 6.48 and 10.49). Cox proportional-hazards (PH) regression with a directed acyclic graph (DAG)-derived minimal adjustment set (age, sex, diabetes mellitus, hypertension, serum creatinine, and Killip class) was used to estimate associations. Predictive performance was evaluated using time-dependent area under the receiver operating characteristic curve (AUC), C-index, bootstrap optimism correction, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). During a median follow-up of 30.0 months, 118 patients (25.4%) experienced MACEs. Patients in the highest AWR tertile were older and less likely to be male than those in the lowest tertile. Higher AWR was independently associated with lower MACE risk [per 1-standard deviation (1-SD) increase: hazard ratio (HR) 0.52, 95% confidence interval (CI): 0.40-0.68, P<0.001; highest vs. lowest tertile: HR 0.40, 95% CI: 0.24-0.65, P<0.001]. The protective association strengthened after the first month. Adding AWR to the Global Registry of Acute Coronary Events (GRACE) 2.0 and Thrombolysis in Myocardial Infarction (TIMI) scores significantly improved reclassification (IDI and NRI both P<0.01). A lower admission AWR is associated with an increased risk of long-term MACEs in STEMI patients undergoing primary PCI, supporting its potential as a prognostic biomarker.
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BibTeX
@article{zeng2026prognostic,
title = {{Prognostic value of the apelin-12-to-white blood cell ratio for long-term major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a retrospective cohort study.}},
author = {Xiaojun Zeng and Chongjian Zhang and Liu Yang and Liuyuan Li and Dandong Luo and Xiaofeng Li},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1360},
url = {https://europepmc.org/article/MED/42996938},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Prognostic value of the apelin-12-to-white blood cell ratio for long-term major adverse cardiovascular events in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a retrospective cohort study.
AU - Xiaojun Zeng
AU - Chongjian Zhang
AU - Liu Yang
AU - Liuyuan Li
AU - Dandong Luo
AU - Xiaofeng Li
PY - 2026
DA - 2026/09/29
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1360
UR - https://europepmc.org/article/MED/42996938
AB - Despite advances in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), patients remain at risk for long-term major adverse cardiovascular events (MACEs). The apelin-12/white blood cell ratio (AWR), a ratio has never been studied before, may reflect the balance between cardioprotective apelin signaling and systemic inflammation. We examined the prognostic value of admission AWR for long-term MACEs in STEMI patients after primary PCI. This secondary analysis included 464 consecutive STEMI patients who underwent primary PCI at The First People's Hospital of Taizhou (Zhejiang, China) between January 2010 and October 2014. Blood samples were collected on admission, immediately before primary PCI, for apelin-12 measurement. Patients were followed for 30 months. MACE was defined as the composite of cardiac death, cardiogenic shock, congestive heart failure, recurrent target-vessel myocardial infarction, or clinically driven target-lesion revascularization. AWR was analyzed as a continuous variable and by pre-specified tertiles (cut-points 6.48 and 10.49). Cox proportional-hazards (PH) regression with a directed acyclic graph (DAG)-derived minimal adjustment set (age, sex, diabetes mellitus, hypertension, serum creatinine, and Killip class) was used to estimate associations. Predictive performance was evaluated using time-dependent area under the receiver operating characteristic curve (AUC), C-index, bootstrap optimism correction, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). During a median follow-up of 30.0 months, 118 patients (25.4%) experienced MACEs. Patients in the highest AWR tertile were older and less likely to be male than those in the lowest tertile. Higher AWR was independently associated with lower MACE risk [per 1-standard deviation (1-SD) increase: hazard ratio (HR) 0.52, 95% confidence interval (CI): 0.40-0.68, P<0.001; highest vs. lowest tertile: HR 0.40, 95% CI: 0.24-0.65, P<0.001]. The protective association strengthened after the first month. Adding AWR to the Global Registry of Acute Coronary Events (GRACE) 2.0 and Thrombolysis in Myocardial Infarction (TIMI) scores significantly improved reclassification (IDI and NRI both P<0.01). A lower admission AWR is associated with an increased risk of long-term MACEs in STEMI patients undergoing primary PCI, supporting its potential as a prognostic biomarker.
SN - 2072-1439
SN - 2077-6624
ER -