The Long-term Prognostic Value Of ApoB/A1 Ratio In Patients With Myocardial Infarction Without Obstructive Coronary Artery Disease

Background:Myocardial infarction without obstructive coronary artery disease(MINOCA)is a special syndrome with clear evidence of myocardial ischemia,but no clear stenosis of coronary artery imaging data.At present,there is still a lack of large sample,medium and long-term follow-up cohort of MINOCA patients in China.Apolipoprotein(Apo),as an atherogenic factor,plays a unique role in the occurrence and development of various coronary artery diseases.The ratio of two apolipoproteins with different functions(ApoB/A1)is closely related to TC/HDL-C.Both of them are considered to be new composite prediction models for the evaluation of atherosclerotic cardiovascular disease.This study focuses on the correlation between ApoB/A1 ratio and the prognosis of MINOCA patients and its value in long-term prognosis evaluation.Methods:This study was a single-center,observational clinical cohort study.A total of 1179 MINOCA patients who underwent coronary angiography in Fuwai Hospital from January 2015 to December 2019 and met the inclusion criteria were enrolled in this study.The clinical data,hematological test results,electrocardiogram,echocardiography and coronary angiography data of the patients were collected,and the patients were followed up by telephone and outpatient examination for a median time of 41.7 months.The revisits,readmissions and daily symptoms were recorded during the follow-up period.The primary endpoint of this study was major adverse cardiovascular events(MACE),which was a composite of non-fatal myocardial infarction,all-cause death,repeat revascularization as assessed by a specialist,non-fatal stroke,recurrent episodes of unstable angina or heart failure,and uncontrollable re-hospitalization.The baseline characteristics of blood lipids and clinical outcomes of patients with MINOCA were collected and analyzed.The patients were divided into groups according to the median of ApoB/A1 ratio.The baseline and prognosis of patients in different groups were compared,and the prognostic evaluation efficacy of each blood lipid index was evaluated.Spearman correlation analysis,multivariate Cox regression analysis,K-M curve and ROC curve were used to explore the specificity and sensitivity of ApoB/A1 ratio in predicting recurrent adverse cardiovascular events in MINOCA patients.Results:(1)Baseline data:the median ApoB/A1 ratio was 0.596.The higher the baseline ApoB/A1 and TC/HDL-C levels,the higher the incidence of MACE.The ApoB/A1 group(HR=1.57;95%CI:1.160-2.133 P=0.004),TC/HDL-C group(HR=1.38;95%CI:1.00-1.91 P=0.048)(2)The relationship between ApoB/A1 ratio and the incidence of MACE in MINOCA patients:ApoB/A1 group was associated with reduced survival rate and increased CV events(HR=1.57;95%CI:1.160-2.133 P=0.004),TC/HDL-C ratio had the same relationship(HR=1.38;95%CI:1.00-1.91 P=0.048).After multivariate adjustment,ApoB/A1 ratio was still an independent predictor of MACE(HR 1.75,95%CI:1.10-2.81;p<0.001).(3)Comparison of the predictive value of different lipid ratios in the prognosis of MINOCA patients:in the ROC curve,both TC/HDL-C score and ApoB/A1 ratio could accurately predict the occurrence of MACE,with AUC of 0.69 and 0.65,respectively.Conclusions:Lipid metabolism is closely related to the development of disease and adverse events in patients with MINOCA.The balance between pro-atherosclerotic and anti-atherosclerotic lipid components plays an important role in the prognosis of this kind of disease.The ApoB/A1 ratio and TC/HDL-C ratio are closely related to cardiovascular risk in patients with MINOCA,and have moderate predictive accuracy.Routine assessment of both ratios may help this specific population benefit from the prognostic information they provide.