Correlation Analysis Of Serum Creatinine/cystatin C Ratio With Multi-vessel Disease And Risk Stratification Of NSTE-ACS

Background:Non-ST-segment elevation acute coronary syndrome(NSTE-ACS)is a group of acute myocardial ischemia syndrome.About 40%-70%of NSTE-ACS patients are associated with multi-vessel coronary artery disease,which is associated with low recanalization rate and high risk of mortality.Early diagnosis and accurate risk stratification are the prerequisite for the treatment of NSTE-ACS,which will also have an important impact on the long-term prognosis of patients.Global registry of acute coronary events(GRACE)risk score is used to predict the risk of NSTE-ACS.It can quickly screen high-risk patients and plays an important role in evaluating in-hospital mortality and prognosis of NSTE-ACS.Sarcopenia is a syndrome of muscular dystrophy and impaired function which is related to the occurrence and clinical outcome of coronary heart disease.Serum creatinine/cystatin C ratio is a newly proposed sarcopenia index(SI),which is related to the poor prognosis of obstructive heart disease,but the relationship between SI and the severity of coronary artery disease and disease risk is still unclear.No study has reported the significance of SI in multi-vessel disease and risk stratification of NSTE-ACS.The purpose of this study was to explore the relationship between SI and multi-vessel disease and GRACE Risk score in patients with NSTE-ACS,so as to provide reference for the identification of NSTE-ACS multi-vessel disease and high-risk population.Objective:To study the difference of SI in NSTE-ACS with different number of coronary arteries;to clarify the relationship between SI and multi-vessel disease;to clarify the relationship between SI and different risk stratification;to explore the predictive value of SI in multi-vessel disease and high-risk stratification of NSTE-ACS.So as to provide help for early identification,risk stratification and diagnosis and treatment of patients with multi-vessel disease.Methods:A total of 251 patients who were diagnosed as NSTE-ACS and underwent coronary angiography in the Department of Cardiology,the Second Hospital of Shandong University from August 2019 to June 2021 were selected as the study group and 132 patients who underwent coronary angiography without coronary heart disease as the control group.This was a retrospective study.The NSTE-ACS group was divided into several groups according to the number of coronary artery lesions and GRACE risk score;the SI and coronary artery disease score(Gensini scores)of patients in different groups were compared.Spearman correlation analysis confirmed the relationship between SI and multi-vessel disease and risk stratification in patients with NSTE-ACS.Multivariate Logistic regression analysis explored the risk factors of multi-vessel disease and risk stratification in patients with NSTE-ACS.ROC curve to evaluate the predictive value of SI in NSTE-ACS multi-vessel disease and high-risk stratification.Results:1.The level of SI in NSTE-ACS group was lower than that in control group(p<0.05);the level of SI in NSTE-ACS multi-vessel disease group was lower than that in single-vessel disease group(p<0.05),and the Gensini score in multi-vessel disease group was higher than that in single-vessel disease group(p<0.05).2.Correlation analysis showed that SI was negatively correlated with multi-vessel disease(r=-0.548,p<0.001).Multivariate Logistic regression analysis showed that low SI(OR=0.918,p<0.001)was an risk factor for multi-vessel disease.3.In the ROC curve,the area under the curve of SI for predicting multi-vessel coronary artery disease was 0.771,95%CI:0.713-0.829,the sensitivity was 81.2%,and the specificity was 60.2%.4.Compared with the GRACE Risk score subgroups,the SI of the high-risk group was lower and the Gensini score was higher than that of the low-and medium-risk group.The SI was negatively correlated with the risk stratification(r=-0.531,p<0.001);Logistic regression analysis showed that low SI(OR=0.896,p<0.001)was a risk factor in the high risk group.5.In the ROC curve of SI predicting high-risk NSTE-ACS,the area under the curve is 0.895,95%CI is 0.692-0.817,the sensitivity is 67.8%,and the specificity is 75.0%.Conclusion:1.SI is related to the occurrence of NSTE-ACS.Patients with NSTE-ACS multi-vessel disease have lower SI value and higher coronary Gensini score.2.SI is associated with multi-vessel disease in NSTE-ACS and low SI is a risk factor for multi-vessel disease.3.Patients with NSTE-ACS in high risk group have lower SI.4.SI is associated with NSTE-ACS risk stratification,and low SI is a risk factor in high risk group.5.SI can predict multi-vessel disease and high risk stratification according to GRACE score in patients with NSTE-ACS.