Correlation of residual cholesterol with coronary artery lesion and prognosis in young patients with acute non-ST-segment elevation myocardial infarction
Correlation of residual cholesterol with coronary artery lesion and prognosis in young patients with acute non-ST-segment elevation myocardial infarction
Objective To investigate the correlation of residual cholesterol(RC)with the coronary artery lesion and prognosis in the young patients with acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods A total of 754 patients with NSTEMI who were first diagnosed in Cangzhou People's Hospital from January 2018 to January 2023 were enrolled.According to the age of onset,the patients were divided into the youth group(＜45 years old)143 cases and the middle-aged and elderly group(≥45 years old)611 cases.All the patients received the standardized coronary heart disease treatment.The general clinical data of the patients were collected and the RC were calculated according to the fasting blood lipids.The data of the two groups were compared;multivariate logistic regression was used to analyze the influencing factors of NSTEMI in the young people.SYNTAX score was counted in the young group through coronary angiography.The young group were followed up and the endpoint of follow-up was the occurrence of major adverse cardiovascular events(MACE).According to the prognosis of the young group,they were divided into MACE group(n=37)and non-MACE group(n=106).The data of the two groups were compared.Multivariate Cox proportional hazard regression was used to analyze the influencing factors of MACE in the young NSTEMI patients.Spearman correlation analysis was used to analyze the correlation between low density lipoprotein cholesterol(LDL-C)and RC and SYNTAX score.Receiver operating characteristic curve(ROC)was used to evaluate the predictive value of RC and LDL-C for MACE in the young NSTEMI patients.According to the optimal survival curve analysis showed that there was significant difference in non-MACE rate between the high RC group and low RC group in the young NSTEMI patients.cut-off value,young NSTEMI patients were divided into high RC group and low RC group.Kaplan-Meier survival curve was used to compare the difference of non-MACE rate between RC groups.Results Compared with the middle-aged and elderly group,the proportions of male and smoking were significantly increased,the levels of uric acid,total cholesterol(TC),triglyceride(TG),LDL-C and RC were signifiicantly increased and high density lipoprotein cholesterol(HDL-C)was significantly decreased in the young group(P＜0.01).Multivariate binary logistic regression analysis showed that male,smoking history,uric acid,HDL-C,LDL-C and RC were all the related factors of NSTEMI in the young people(P＜0.05).Spearman correlation analysis showed that LDL-C(r=0.254,P=0.002)and RC(r=0.302,P＜0.001)were positively correlated with SYNTAX score.The LDL-C,RC and SYNTAX scores of the young NSTEMI patients in the MACE group were higher than those in the non-MACE group,and the difference was statistically significant(P＜0.01).Multivariate Cox regression analysis showed that RC,LDL-C and SYNTAX score were the independent risk factors for MACE in the young NSTEMI patients.The AUC of RC was 0.767 in predicting MACE in the young NSTEMI patients,the sensitivity was 67.6 and the specificity was 77.4％,and the best cut-off value of RC was 0.935 mmol/L.Survival curve analysis showed that there was significant difference in the non-MACE rate between high RC group and low RC group in the young NSTEMI patients(Log-rank x2=17.464,P＜0.001).Conclusion RC is the independent risk factor for the young NSTEMI and positively correlated with the severity of coronary artery disease in the young NSTEMI patients,which has certain value for the prognosis evaluation.
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