Study On The Severity And Prognostic Risk Factors Of Coronary Artery Disease In Patients With Non-st Elevation Acute Coronary Syndrome

Background:Coronary artery atherosclerotic heart disease is a kind of heart disease caused by coronary artery atherosclerosis,which causes stenosis or obstruction of vascular lumen,myocardial ischemia,hypoxia or necrosis.It is often divided into stable coronary heart disease and acute coronary syndrome.Acute coronary syndrome is a manifestation of coronary artery disease,including acute myocardial infarction and unstable angina pectoris.It has been proved that inflammation and lipid play an important role in the occurrence and development of atherosclerosis and cardiovascular diseases.The prevalence of cardiovascular diseases in China is rising steadily,and the mortality rate is the highest among all causes,accounting for more than 40%of the deaths caused by diseases among residents.The type of coronary artery disease is also a major problem for patients and doctors.The number and proportion of multi-vessel disease,bifurcation disease,left main artery disease and total occlusion of coronary artery are increasing year by year.According to statistics,as many as half of patients receiving percutaneous coronary intervention suffer from multi-vessel disease,and the number of patients with CTO lesions are also increasing year by year.At the same time,the total cost of hospitalization for cardiovascular diseases is also increasing rapidly,and the burden of cardiovascular diseases is increasing in China.Objictive:To explore the severnty of coronary artery and rnsk factors of CTO lesions in patients with non-ST-segment elevation acute coronary syndrome,and to identify the risk factors affecting the prognosis of patients.Methods:From June 2017 to January 2018,patients with chest pain and precordial discomfort as the first symptoms were admitted to Qilu Hospital of Shandong University and hospitalized.Coronary angiography was performed.The results showed that at least one vessel had stenosis lesions of more than 50%.The patients were enrolled according to the inclusion criteria and exclusion criteria.The patients were enrolled according to the coronary angiography institute.The patients were divided into three groups according to the SYNTAX score,151 patients in mild group(SYNTAX score<22),57 patients in moderate group(SYNTAX score 23-32)and 44 patients in severe group(SYNTAX score<33);all patients were divided into CTO group(54 cases)or non-CTO group(198 cases)according to the presence of CTO lesions.The follow-up time was 6 months and 1 year.The follow-up mode was telephone follow-up and His system inquiry.The main adverse cardiovascular events and the specific time of occurrence were followed up.According to the follow-up results,the patients were divided into MACE group(31 cases)and non-MACE group(221 cases).1.DATA COLLECTION:Gender,age,past history(DM,HT,cerebral infarction,cerebral hemorrhage),personal history(smoking history,drinking history),family history(DM,CHD,HT,cerebral infarction),neutrophil count,lymphocyte count,monocyte count,hemoglobin,red blood cell distribution width,platelet count,platelet distribution width,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,triglyceride,small but low density lipoprotein,blood sugar,homocysteine,urea nitrogen,serum creatinine,cystatin C,uric acid were recorded.The ratio of monocytes to high density lipoprotein cholesterol ratio(MHR)was calculated.2.Statistical processing:All the data in this study were analyzed by SPSS 19.0 software.The independent factors affecting the severnty of coronary artery disease were identified by logistic regression analysis of ordered multi-classified variables.The independent rnsk factors of CTO lesions were explored by binary logistic regression analysis.The independent rnsk factors affecting the occurrence of MACE events were identified by COX regression analysis of multiple factors.Results:1.Univariate analysis:1.1 There were significant differences in age(P=0.004),history of diabetes mellitus(P=0.002),history of hypertension(P=0.041),MHR(P=0.001)and sdLDL(P=0.001)among low-risk group,medium-rnsk group and high-risk group.1.2 There were significant differences in sex(P=0.044),history of DM(P=0.001),sdLDL(P=0.001),SCr(P=0.047)and MHR(P=0.001)between CTO group and non-CTO group.2.Relevance analysis:SYNTAX score was positively correlated with age(r=0.240,5 P=0.001),BG(r=0.140,P=0.026),UA(r=0.174,P=0.006),MHR(r=0.324,P=0.001),SDL(r=0.279,P=0.001),and HB(r=-0.178,P=0.005),with statistical significance(P<0.05).3.Multivariate Logistic Regression3.1 Ordered multi-classification logistic regression:After adjusting for confounding factors,the severity of coronary artery was independently correlated with MHR(OR:15.32,95%CI:4.38-53.57,P = 0.001),age(OR:1.05,95%CI:1.02-1.08,P = 0.001),sdLDL(OR:4.91,95%CI:1.89-12.76,P = 0.001),history of DM(OR:2.27,95%CI:1.23-4.18,P = 0.008).3.2 Bivariate multivariate logistic regression of CTO lesions:After adjusting for confounding factors,MHR(OR:6.68,95%CI:1.53-29.12,P = 0.011),sdLDL(OR:3.20,95%CI:1.03-9.23,P = 0.044),history of DM(OR:3.09,95%CI:1.57-6.06,P=0.001)were independently associated with CTO lesions.4.Survival analysis of 252 patients with coronary heart diseaseAmong 252 patients with coronary heart disease,31 were followed up to MACE events,including 6 cardiac-related deaths,11 non-fatal myocardial infarction,8 target vessel revascularization,2 hemorrhagic stroke,4 ischemic stroke,10 patients were lost to follow-up.4.1 Kaplan-meier survival analysis showed that the risk of future MACE events increased in the elderly group,diabetes group,hypercreatinine group,high MHR group,high LDL-C group,high TC group and high TG group,with statistical significance.4.2 Multivariate COX regression analysis showed that the risk of cardiovascular events in MHR elevated group was higher than that in MHR low group(P=0.001),and that in elderly group was higher(P=0.006).5.Survival analysis of 54 CTO patients with coronary heart disease Follow-up showed that 14 patients had MACE events,including 3 cardiac-related deaths,6 non-fatal myocardial infarction,4 target vessel revascularization,1 stroke and 3 lost follow-up.5.1 Kaplan-meier survival analysis showed that the risk of future MACE events increased in high MHR group(P=0.006),low Rentrop grade group(P=0.034),drug therapy group and unsuccessful revascularization group(P=0.002).5.2 Multivariate COX regression analysis showed that the risk of future MACE events in patients with successful revascularization was significantly lower than that in patients with failed revascularization and drug therapy(HR:0.280;95%CI:0.095-0.828,P=0.021).The results were statistically significant,with high MHR group(HR:2.856;95%CI:0.878-9.286,P=0.081)and low Rentrop group(HR:0.346;95%CI:0.118-1.013,P=0.053)Cardiovascular risk increased,but the results were not statistically significant.Conclusion:1.Ordered multi-classification logistic regression analysis showed that MHR(OR:15.32,95%CI:4.38-53.57,P = 0.001),age(OR:1.05,95%CI:1.02-1.08,P= 0.001),sdLDL(OR:4.91,95%Cl:1.89-12.76,P = 0.001),history of DM(OR:2.27,95%CI:1.23-4.18,P = 0.008)were independently related to the severity of coronary artery.2.Bivariate multivariate logistic regression analysis showed that MHR(OR:6.68,95%CI:1.53-29.12,P = 0.011),sdLDL(OR:3.20,95%CI:1.03-9.23,P = 0.044),history of DM(OR:3.09,95%CI:1.57-6.06,P = 0.001)were independent risk factors for CTO lesions.3.Statistically significant variables in Kaplan-Meier survival analysis included age,diabetes history,serum creatinine,uric acid,LDL-C,MHR,TC and TG.The results showed that the risk of cardiovascular events in MHR elevated group was higher than that in MHR low group(P=0.001),and that in elderly group was higher(P=0.006).4.There were significant variables in Kaplan-meier survival analysis.Rentrop classification,treatment regimen and MHR entered multivariate COX regression analysis.The results showed that the risk of future MACE events in patients with successful revascularization was significantly lower than that in patients with failed revascularization and drug therapy(HR:0.280;95%CI:0.095-0.828,P =0.021).The results were statistically significant in patients with high MHR(HR:2.856).95%CI:0.878-9.286,P = 0.081)and low Rentrop classification group(HR:0.346;95%CI:0.118-1.013,P = 0.053)had increased cardiovascular risk,but the results were not statistically significant.