残余胆固醇与老年急性冠脉综合征患者病变严重程度及预后的相关性

Correlation of residual cholesterol with lesion severity and prognosis in elderly patients with acute coronary syndrome

目的探索残余胆固醇(RC)是否可成为老年冠脉综合征(ACS)患者的危险分层及预后评估指标。方法本研究为回顾性队列研究。连续入组2020年3月至2021年3月于中国人民解放军总医院心血管内科住院的老年ACS患者,通过电子病历系统收集患者的基线临床资料、实验室检查等资料并计算RC水平,通过冠状动脉造影进行基线及残余Syntax评分分析。对所有患者进行随访,随访终点为发生主要不良心血管事件(MACEs)。采用多因素logistic回归模型分析发生MACEs的危险因素,采用受试者工作特征(ROC)曲线评估不同危险因素对ACS患者预后的预测价值,并采用Spearman相关性检验评估RC与冠状动脉病变严重程度的相关性。采用R软件进行数据分析。根据数据类型,组间比较分别采用t检验、Kruskal-Wallis H检验及χ^(2)检验。结果本研究最终入选老年ACS患者740例,其中1年随访期内发生MACEs患者84例(11.35%)。多因素logistic回归分析结果显示,通过校正,低密度脂蛋白胆固醇(OR=0.998,95%CI 0.997~1.000;P=0.015)与RC(OR=0.135,95%CI 0.069~0.265;P<0.001)为老年ACS患者发生MACEs的独立危险因素。ROC曲线分析结果显示低密度脂蛋白胆固醇及RC对预后评估有良好的预测价值,AUC分别为0.754(95%CI 0.719~0.786)、0.774(95%CI 0.740~0.805),二者联合评估预后的效能优于二者单独预测0.868(95%CI 0.840~0.893;P<0.001)。RC与残余Syntax评分的相关系数R 2为0.46,二者呈正相关(P<0.05)。结论RC与老年ACS患者的冠状动脉病变狭窄程度正相关,并对患者MACEs的预后评估具有较好的应用价值。

Objective To explore whether residual cholesterol(RC)can serve as an evaluation indicator for risk stratification and prognosis in the elderly patients with acute coronary syndrome(ACS).Methods This was a retrospective cohort observation study.The cohort included consecutive elderly ACS patients admitted to Chinese PLA General Hospital from March 2020 to March 2021.The baseline clinical data,laboratory examination data,and other data were collected through the electronic medical record system,and RC was calculated.The baseline Syntax score(bSS)and residual Syntax score(rSS)were analyzed through coronary angiography.All patients were followed up,with the endpoint being the occurrence of major adverse cardiovascular events(MACEs).A multivariate logistic regression model was used to analyze the risk factors of the occurrence of MACEs,the receiver operating characteristic(ROC)curve to evaluate the predictive value of different risk factors in the prognosis of ACS patients,and the Spearman correlation test to evaluate the association between RC and the severity of coronary artery.SPSS statistics R was used for statistical analysis.Data comparison between two groups was performed using t test,Kruskal-Wallis H test orχ^(2)test depending on data type.Results Totally 740 elderly ACS patients were enrdled,of whom 84(11.35%)had MACEs during the one-year follow-up.Multivariate logistic regression showed that after adjustment,low-density lipoprotein cholesterol(OR=0.998,95%CI 0.997-1.000;P=0.015)and RC(OR=0.135,95%CI 0.069-0.265;P<0.001)were independent risk factors for MACEs in the elderly ACS patients.The ROC curve analysis showed that LDL-C(AUC=0.754,95%CI 0.719-0.786)and RC(AUC=0.774,95%CI 0.740-0.805)had good predictive value for patients′prognosis,and that the combination of them(AUC=0.868,95%CI 0.840-0.893)was more efficacious than each one alone(P<0.001).The correlation coefficient R 2 between RC and rSS was 0.46,indicating a positive correlation(P<0.05).Conclusion RC is positively correlated with the degree of coronary artery stenosis and is valuable in predicting MACEs in the elderly ACS patients.