Correlation Analysis Between Cys C With Degree Of Coronary Artery Disease And Prognosis In Patients With Non-obstructive Coronary Myocardial Infarction

Objective:This study aims to investigate the relationship between serum cystatin C(Cys C)levels and the degree of coronary artery disease in patients with coronary artery non-obstructive myocardial infarction(MINOCA),and its influence on the prognosis,in order to provide serological reference for clinical evaluation of patients’ condition.Methods:A preliminary diagnosis of acute myocardial infarction(AMI)and percutaneous coronary angiography(CAG)were performed at the First Central Hospital of Baoding City from January 2017 to December 2019.The results showed coronary vascularity.Diameter stenosis <50%,99 patients diagnosed with MINOCA,all met the inclusion and exclusion criteria.According to the results of coronary angiography,all patients were divided into normal coronary artery group(no coronary artery stenosis or stenosis degree <30%)and mild coronary artery stenosis group(30%≤coronary artery stenosis <50%).All patients were followed up for 12 months in outpatient clinic and/or telephone.The medications used outside the hospital and the occurrence of major adverse cardiovascular events(MACE)were recorded,and they were divided into event group and non-event group.Collect baseline data of all patients,including the patient’s gender,age,height,weight,smoking history,family history of cardiovascular disease,past medical history(such as hypertension,diabetes,etc.),triglycerides(TG),low-density lipoprotein(LDL),total cholesterol(CHO),blood sugar(Glu),left ventricular ejection fraction(LVEF),etc.,and calculate the patient’s body mass index(BMI = weight(kg)/ height 2(m2)).Serum Cys C,creatinine(Cr),β2 microglobulin(β2-MG)measured in fasting venous blood collected within 24 hours of admission were recorded,and the patient’s glomerular filtration rate(e GFR)was calculated based on the calculation.The patient’s serum Cys C was measured by an immunoprojection turbidimetric method using an automatic electrochemical detector made by Roche,Germany,and the normal range was 0-1.17mg/L.Taking the normal value of Cys C level 1.17mg/L as the boundary value,all patients were divided into two groups,<1.17mg/L was the normal group,and≥1.17mg/L was the elevated group.Spearman correlation analysis method was used to analyze the correlation between serum Cys C level and the degree of coronary artery disease,and the COX proportional hazard model was used to analyze the risk ratio(HR)and 95% confidence interval(CI).The Kaplan-Meier method was used to calculate the cumulative incidence of MACE events between the two groups,and the Log-Rank test was used to compare the differences in the cumulative incidence of events between the two groups.Using the test level α=0.05,P<0.05,the difference was considered statistically significant.Results:1 Comparison of clinical data between normal coronary artery group and mild coronary artery stenosis group There was no difference in gender,age,BMI,smoking history,history of hypertension,history of diabetes,family history of cardiovascular disease,TG,LDL,CHO,Glu,β2-MG,e GFR,and LVEF between the two groups(P>0.05).The level of serum Cys C in the mild coronary artery stenosis group was higher than that in the normal coronary artery group(P<0.05).2 Correlation between serum Cys C level and the degree of coronary artery disease in MINOCA patients Serum Cys C levels in MINOCA patients are positively correlated with the degree of coronary artery disease(rs=0.458,P<0.01).3 Comparison of clinical data between event group and non-event group of MINOCA patients There was no difference in gender,history of hypertension,history of diabetes,family history of cardiovascular disease,TG,LDL,and LVEF between the two groups(P>0.05).There was no difference between the two groups of patients taking ADP receptor antagonists,statins,and ACEI/ARB drugs outside the hospital(P>0.05).The age,smoking history,and serum Cys C levels of the two groups were compared,the age,smoking history ratio,and serum Cys C levels of the event group were higher than those of the non-event group(P<0.05).4 Comparison of the cumulative incidence of MACE in MINOCA patients with different Cys C levels The average follow-up time was 11.44±1.86 months.10 MACE events occurred,including 8 cases in the Cys C level increase group and 2 cases in the normal group.The Kaplan-Meier method was used to calculate the cumulative incidence of MACE events.The cumulative incidence of the high group was 4% and 18%,respectively.There was a statistically significant difference in the cumulative incidence between the two groups by Log-Rank test(P<0.05).5 COX regression analysis of the impact of Cys C level on MACE events in patients with MINOCA The 12-month follow-up MACE event was used as the dependent variable,and the serum Cys C level was used as the independent variable.After adjusting for confounding factors such as age and smoking history,the results showed that MACE events in the increased Cys C level group were higher than those in the normal Cys C level group(HR=5.442,95%CI1.410-20.999,P<0.05).Conclusion:1 Serum Cys C level was positively correlated with the degree of coronary artery lesions in MINOCA patients,which could provide clinical serological reference.2 High-level Cys C is an independent risk factor for adverse prognostic events in MINOCA patients.