Relationship Between Serum Lipid Level And Severity Of Coronary Artery Lesion Of Young Males With Acute Coronary Syndrome

Objective: To analyze the characteristics of coronary artery lesions that occurs to young males who are suffering from acute coronary syndrome, and to investigate the correlation between serum lipid level and severity of coronary artery stenosis. Methods: From January 2012 to August 2014, 604 patients, undergoing coronary angiography or percutaneous coronary intervention, had been diagnosed with acute coronary syndrome and received treatment in the Department of Cardiology of Affiliated Hospital of Zunyi Medical College. And 186 cases of male patients were chosen to make a retrospective study. The definite steps are as follows: All eligible patients were divided into two groups, Young males group(≤44 years old, n= 80) and Elderly males group(the control group, ≥60 years old, n=106). In order to analyze the difference of clinical type, complications, coronary angiography and serum lipid level between these two groups, multivariate linear regression analysis is selected to obtain the relationships between the components of serum lipid level and coronary artery stenosis Gensini score. After calculating we can list the regression equation lipid levels. Result:(1). The males group group members were aged from 16 to 44 years old(avg 40.1 ± 5.0 years old), elderly males group members were aged from 60 to 87 years old(avg 68 ± 6.8 years old), both group members were mainly afflicted with ST-segment elevation myocardial infarction, no statistical difference in clinical types significance(P > 0.05). Compared with the elderly group’s Killip classification, young males group’s KillipⅠgrade [80.0%(64/80) vs.65.1%(69/106), P <0.05], KillipⅡ grade cases no significant difference, KillipⅢ grade [0 vs.5.7%(6/106), P <0.05], Killip Ⅳ grade [0 vs. 6.6%(7/106), P <0.05].Arrhythmia, ventricular fibrillation [0 vs. 5.7%(6/106), P < 0.05], other types of arrhythmias were not statistically significant different. Young males group had no ventricular septal perforation or mural thrombosis cases, but the elderly group had one case for each, and both died in 30 days. [0 vs.6.6%(7/106), P <0.05], GRACE risk score [(116.5 ± 19.6) vs.(164.3 ± 27.3), P <0.001], Predicted mortality in hospital during 30 days [(1.7 ± 1.4) %vs.(8.3 ± 8.9)%, P <0.001], the difference was statistically significant.(2). Comparison of coronary artery lesions: coronary angiography showed that the young males group was more common to catch a single coronary artery disease, while the elderly group was dominated by double-vessel disease. Compared with the elderly group [single-vessel disease: 51.3%(41/80) vs. 27.4%(29/106), double vessel disease: 27.5%(22/80)vs. 48.1%(51/106), multivessel disease: 21.2%(17/80) vs. 24.5%(26/106), P <0.005], vascular lesions constitute was statistically significant different in the distribution ratio. Two groups’ culprit vessels were mainly in left anterior descending artery, and secondly was the right coronary artery. There were no statistically significant differences between the two groups’ criminals vascular stenosis(P > 0.05). Compared the culprit lesion types, the young males group was more likely to catch limitations of lesions [38.8%(31/80) vs. 23.6%(25/106), P < 0.05], elderly group mainly got the diffuse lesions [25.0%(20/80)vs. 48.1%(51/106), P < 0.005], tubular lesions had no significant statistical difference between two groups(P > 0.05). Young males group’s culprit lesions occurred mainly in the vascular middle(51.2%, 41/80), while the elderly group’s culprit vascular disease occured mainly in the proximal segment(46.2%, 49/106), the distribution of the culprit lesion in the proximal, middle, distal and branch vessels between the two groups was statistically significant(P <0.05). Compared with the elderly group, the young males group had a lower coronary artery stenosis Gensini score [(55.3 ± 30.7) vs.(65.9 ± 29.0), P <0.05].(3). Lipids and creatinine levels: In young males group, the levels of triglyceride, total cholesterol, low density lipoprotein cholesterol, apolipoprotein B and apo B/apo A ratio were higher than that of the elderly group(P < 0.05). There was no statistically significant difference between two groups’ high-density lipoprotein cholesterol and apolipoprotein A.(4). Lipid levels and Gensini score correlation: In the young males group, total cholesterol, LDL cholesterol, apolipoprotein B and apolipoprotein B / apolipoprotein AⅠ’s ratio was positively correlated with the Gensini score, pearson correlation coefficients were(r = 0.396, P = 0.001),(r = 0.380, P = 0.001),(r = 0.306, P = 0.006),(r = 0.262, P = 0.019).Multiple linear regression analysis showed that only low-density lipoprotein cholesterol was in the regression equation: y ^ = 25.240 + 8.682 LDL cholesterol, which had linear regression relationship with the Gensini score, Gensini score increases with elevated low-density lipoprotein cholesterol. Elderly group’s high-density lipoprotein cholesterol and apolipoprotein AⅠwas negatively correlated with the Gensini score. And apolipoprotein B/ apolipoprotein A ratio was positively correlated with the Gensini score, pearson correlation coefficients were(r =-0.374, P = 0.000),(r =-0.296, P = 0.002),(r = 0.278, P = 0.004).Multiple linear regression analysis showed that only high-density lipoprotein cholesterol was in the regression equation: y ^ = 114.623-46.803 high-density lipoprotein cholesterol. Its presence linear regression relationship with Gensini score was that Gensini score got lower when high-density lipoprotein cholesterol increased. Conclusion: The coronary artery disease attacks young males who suffer from acute coronary syndrome is typically single vessel localized lesions. The culprit artery is more common to be seen in the left anterior descending artery, and vascular lesions is often located in the middle. The rate of Clinical comorbidity and complications is lower than that of the elderly group, and the average lipid levels is higher than that of the elderly group. LDL cholesterol and Gensini scores are independently and positively correlated. In addition, LDL cholesterol is an independent predictor of Gensini scores, the higher the LDL cholesterol levels is, the more severe the coronary artery disease is.