| Objectives To explore the residual risk factors of recurrent acute coronary syndrome in patients with coronary heart disease in different situations of traditional risk factor control.To analyze the relationship between the residual risk factors of acute coronary syndrome and the number of diseased coronary arteries in patients with coronary heart disease.Methods Select the re-hospitalized patients with coronary heart disease who were admitted to the Department of Cardiology of Affiliated Hospital of North China University from2020.11 to 2021.11 and 173 patients(54.75%)with acute coronary syndrome were included in acute coronary syndrome group(ACS group),while 143 patients(45.25%)with stable angina pectoris were included in stable angina pectoris group(SAP group).Recorded general clinical data,blood routine index,liver function index,renal function index,glycosylated hemoglobin and lipoprotein associated phospholipase A2 level.To compare the differences of liver function index,renal function index,blood lipid index,Lp-PLA2,ratio of monocyte to high density lipoprotein(MHR)between SAP group and ACS group.To analyze whether the above indexes are independent risk factors for recurrent acute coronary syndrome in patients with coronary heart disease.A total of 316 patients were stratified according to the standard of traditional risk factors.To compare the levels of Lp-PLA2,MHR,total bile acid(TBA)and residual cholesterol(RC)between ACS patients and SAP patients.A total of 316 patients were divided into single-vessel disease group,two-vessel disease group and threevessel disease group.The levels of Lp-PLA2,MHR,TBA and RC in patients with different number of diseased coronary arteries were compared.All data were analyzed by using t-test,analysis of variance,χ2-test,Mann-Whitney U test,rank sum test and logistic regression by SPSS 28.0 and we will investigate whether MHR and TBA are residual risk factors for recurrent ACS in patients with coronary heart disease.Results 1 There was no significant difference in the attainment rate of LDL-C and non HDL-C between ACS group and SAP group(15.61% vs 16.08%,30.06% vs 36.36%,P<0.05).2 Compared with SAP group,apolipoprotein A level in ACS group was lower(1.43±0.29 vs 1.36±0.31g/L,P<0.05).Compared with SAP group,Ln TBA and Ln MHR were higher in ACS group(1.08±0.85 vs 1.32±0.89μmol/L,-1.69±0.62 vs-1.49±0.63,P<0.05).3 Elevated levels of MHR and TBA are independent risk factors for recurrent ACS in patients with coronary heart disease(OR=1.983,95%CI: 1.254-3.137,P<0.05)(OR=1.061,95%CI: 1.002-1.124,P<0.05).4 There were 119 patients with good control of 1-2 traditional risk factors.These patients were divided into ACS group(66 cases)and SAP group(53 cases).Ln MHR of ACS group was higher than that of SAP group(-1.47±0.55vs-1.69±0.63,P<0.05).5 There were 166 patients with good control of 3 traditional risk factors.These patients were divided into ACS group(90 cases)and SAP group(76 cases).Ln MHR and Ln TBA in ACS group was higher than that in SAP group(-1.53±0.66 vs-1.73±0.60,1.35±0.85 vs 0.96±0.83μmol/L,P<0.05).6 There were 31 patients with good control of 4 traditional risk factors.These patients were divided into ACS group(14 cases)and SAP group(17 cases).There was no significant difference in Lp-PLA2,MHR,TBA and RC level between ACS group and SAP group(P>0.05).7 According to the number of diseased branches of coronary artery,316 patients were divided into single-vessel disease group(n=107),two-vessel disease group(n=81)and three-vessel disease group(n=128).In the ordered logistic regression analysis,MHR had a significant positive effect on the number of diseased branches(OR=3.581,95%CI: 1.032-12.426,P<0.05).8 Patients with SAP were divided into three groups: single-vessel disease group(n=60),two-vessel disease group(n=43)and three-vessel disease group(n=40).In the ordered logistic regression analysis,MHR had a significant positive effect on the number of diseased branches(OR=13.075,95%CI: 1.520-112.449,P<0.05).Conclusions 1 MHR and TBA are residual risk factors of recurrent ACS in patients with coronary heart disease.2 Among the patients whose two traditional risk factors were controlled,the MHR of patients with recurrent ACS was higher than that of patients with SAP.3 Among the three traditional risk factors controlled,the levels of MHR and TBA in patients with recurrent ACS were higher than those in patients with SAP.4 Among the patients whose four traditional risk factors were controlled,there was no significant difference in the levels of Lp-PLA2,MHR,TBA and RC between recurrent ACS patients and SAP patients.5 The increase of MHR is a positive factor affecting the number of diseased coronary arteries.Figure0;Table17;Reference 172... |
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