Differences in coagulation and inflammatory markers between STEMI and NSTEMI and their predictive value for MACE: a retrospective cohort study

Abstract Objective To compare the differences in coagulation function and inflammatory factor levels between patients with acute ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), and to investigate their correlations with the risk of major adverse cardiovascular events (MACE). Methods A retrospective cohort study design was adopted. A total of 232 consecutive patients with acute myocardial infarction (AMI) admitted to Wuhan Asia Heart Hospital between January 2023 and December 2024 were enrolled, including 117 patients in the STEMI group and 115 in the NSTEMI group. Clinical data at admission were collected, and coagulation parameters [including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-dimer (D-D)] as well as inflammatory markers [including white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6)] were measured. All patients were followed up for 1 year, and the occurrence of MACE was recorded. SPSS 26.0 software was used for intergroup comparisons, correlation analyses, and multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive efficacy of coagulation and inflammatory indicators for MACE within 1 year. Results The levels of PT, FIB, D-D, WBC, NLR, hs-CRP, and IL-6 in the STEMI group were significantly higher than those in the NSTEMI group (all P < 0.05), whereas no statistically significant difference was observed in APTT levels between the two groups. During the follow-up period, the cumulative incidence of MACE in the STEMI group (66.67%) was significantly higher than that in the NSTEMI group (42.61%) ( P < 0.001). Among all AMI patients, higher Killip functional class was associated with elevated levels of FIB, D-D, IL-6, hs-CRP, WBC, and NLR (all P < 0.05). Correlation analysis revealed that FIB and D-D levels were significantly positively correlated with each inflammatory factor level (all P < 0.05). FIB and IL-6 were associated with MACE in multivariate logistic regression (FIB: OR = 2.040, 95% CI: 1.203–3.460 ; IL-6 : OR = 1.106, 95% CI: 1.044–1.171), but this association was not sustained in time-to-event analysis. ROC curve analysis showed that FIB, IL-6, and their combined model all had significant predictive value for MACE (all P < 0.001).However, IL-6 alone achieved an AUC of 0.821 for predicting MACE, and the addition of FIB yielded only a minimal, non-significant improvement (AUC = 0.830, P = 0.457). Conclusion STEMI patients exhibit a more pronounced coagulation-inflammatory activation state and a higher risk of MACE compared with NSTEMI patients. FIB and IL-6 can serve as effective baseline risk indicators, helping to identify high-risk patients at initial presentation. While these markers may not independently predict long-term time-to-event outcomes in our cohort, their utility in enhancing early risk awareness and complementing existing clinical evaluation warrants consideration.